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VOLUME 33 NUMBER i

BULLETIN

^L OF tAe-:^ OF THE

SCHOOL of MEDICINE

UNIVERSITY OF MARYLAND
JULY, 1948

PUBLISHED FIVE TIMES A YEAR
(JANUARY, APRIL, JULY, SEPTEMBER, AND OCTOBER)

Lombard and Greene Streets
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Bulletin of the School of Medicine, University of Maryland

BOARD OF EDITORS

Matjrice C. PmcoFFS, B.S., M.D., Chairman

Carl D. Clarke, Ph.D., Managing Editor

Frances M. Blackburn, B.A., Associate Editor

John C. Krantz, Jr., Sc.D., Ph.D. C. Gardner Warner, A.B., M.D.

Andrew C. Gillis, M.A., M.D., LL.D. Louis A. M. Krause, M.D.

Walter D. Wise, M.D. Otto C. Brantigan, B.S., M.D.

John A. Wagner B.S., M.D.

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■^ ^^ OF \i^^-~^^

BULLETIN

OF THE

SCHOOL of MEDICINE

UNIVERSITY OF MARYLAND

VOLUME 33 No. I

Publishers:

Faculty of Physic

University of Maryland

Baltimore

PUBLISHED FIVE TIMES A YEAR
(JANUARY, APRIL, JULY, SEPTEMBER AND OCTOBER)

Lombard and Greene Streets
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Entered as second-class matter June 16, 1916, at the Postoffice at Baltimore. Manland
under the Act of August 24, 1912.

BULLETIN

OF THE

SCHOOL OF MEDICINE

UNIVERSITY OF MARYLAND

Vol. 33 JULY, 1948 No. 1

A REPORT ON THE USE OF SOTRADECOL
A NEW SCLEROSING AGENT*t

ROSS Z. PIERPONT, M.D. and OTTO C. BRANTIGAN, M.D.

BALTIMORE, MD.

Many different solutions have been used for the sclerosing treatment of
varicose veins. Destruction of the intima of the vein with production of a
firm thrombus is the basic reaction of all the various sclerosing solutions.
Organization of the thrombus forms fibrotic tissue, which results in perma-
nent obHteration of the vein.

The mode of action of sclerosing agents allows them to be brought into
two rather distinct groups (2) :

1, The agents whose action can be correlated with the physical properties
of their solutions, such as the soaps and hypertonic solutions. The soap
solutions, such as sodium morrhurate, sodium ricinoleate, sodium psylliate,
monoethanolamine oleate, sodium linoleate, jecoroleate, and potassium
oleate are ahke, because the soaps are present in the form of coUoidal micelles.
They are more or less alkahne and have a low surface tension. The hyper-
tonic solutions of crystalloid compounds, such as sodium chloride, calcium
chloride, sodium ortrate, dextrose, and others act through dehydration by
osmosis.

2. The agents which react chemically with components of cells and tissues.
In this group are the heavy metals, such as mercury bichloride, mercuric
iodide, and iron perchloride; certain organic compounds which react with
proteins, such as sodium saHcylate, quinine hydrochloride, and urethane;
compounds which contain reactive halogens, such as tincture of iodine,
Lugol's solution, Pregl's iodine solution, and, finally, strongly alkaline solu-
tions such as sodium carbonate.

* From the Department of Surgery, School of Medicine, University of Maryland,
t Received for publication December 2, 1947.

2 BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

The use of soap solutions has been disappointing because of serious aller-
gic or anaphylactoid reactions ranging from simple skin eruptions to shock
and even sudden death (3, 10). The soap solutions are also definitely vari-
able in their reaction (5) and the venous obhterations produced are often
not permanent. The second group of agents has been found objectionable
because of a rather diffuse tissue damage often extending beyond the walls
of the veins and involving the perivenous tissues. This objection is also
present with the hypertonic solutions which must be used in such strong con-
centrations that diffusion creates damaging concentrations in perivenous
tissues.

The possibihty was conceived that the effectiveness and safety of a scleros-
ing solution could be increased by the use of substances whose surface activ-
ity is greater than that of soap solutions and which at the same time can be
synthesized and obtained in pure form. By the use of such a S)nithesized
product it was felt that the danger of allergens would be minimized, since
organic substances of natural origin would be eliminated.

A quantitative bioassay method has been developed by using the tail
vein of mice (8), and various synthetic surface active agents of the alkyl
sulfate and sulfonate ty^Q- were tested. It was found that those containing
the highly branched chain alkyl residue were much more effective in produc-
ing thrombosis and subsequent obhteration of the veins in experimental
animals than the soap solutions. The agents were also tested for their
irritating properties by subcutaneous injections in rabbits and were found to
be almost entirely free from inflammation producing properties. If they
were injected intradermally, they created a well circumscribed, strongly ne-
crotic lesion, whereas soaplike agents under the same condition produced a
necrosis with a rather wide edematous and erythematous halo.

On the basis of this study, the most useful agent was found to be sodium
tetradecyl sulfate or sotradecol. Its toxicity is of about the same magnitude
as soap solutions (a lethal dose of 50 to 90 mg./kg. injected intravenously in
mice), but since its activity is about two to four times as great as the soap
solutions, the therapeutic index is two to four times that of soap solutions.
The agent is supplied in 1, 3 and 5 per cent solutions.

Beginning in April, 1944, sotradecol was cautiously employed in the treat-
ment of varicose veins. First, it was used on patients who had previously
had a systemic reaction to other sclerosing agents; second, in cases where
there was a past history of allergy; third, on patients who had definite hyper-
tension ; fourth, on patients who failed to obtain obliteration of their vari-
cose veins after injection with other sclerosing agents. The results from the
use of sotradecol in the treatment of varicose veins were so gratifying that its
use became routine about January, 1945.

In this series the patients were, for the most part, subjected to high liga-

PIERFONT AND BRANTIGAN—USE OF SOTRADECOL 3

tion and division of the greater saphenous vein and its tributaries at the
sapheno-femoral junction, and to excision of the blowout areas after the
method described by McPheeters (6). The injection of sotradecol was made
on some patients at the time of operation. It is most probable that patients
with varicose veins which are amenable to injection therapy alone have been
treated by the referring physician, since only a few patients of this series
were suitable for injection treatment without ligation.

The Trendelenburg and modified Perthes tests were used in determining
whether hgation and injection or injection alone should be instituted in the
treatment of the patient. By the proper use of the Trendelenburg test, the
presence or absence of a reverse flow in the superficial veins can be detected
promptly and the degree of hydrostatic pressure within the vein can be esti-
mated. That this is important can be readily appreciated when it is remem-
bered that DeTakats (4) has reported pressures in a valveless great saphe-
nous vein as high as 210 cm. of water.

The Trendelenburg test was evaluated and patients were classified as
Trendelenburg positive, negative, double positive, and nil. The test is
carried out by having the patient stand with both lower Umbs exposed to the
groin. All the superficial veins are inspected and palpated to ascertain their
size and the degree of tension or pressure within the vein. The patient is
then placed in a recumbent position with the leg elevated above the level
of the pelvis. The veins are stroked or milked toward the groin, thus empty-
ing them. A tourniquet is placed around the upper thigh with sufl&cient
pressure to block the superficial veins. The patient stands, and the veins
below the tourniquet may remain collapsed for a few seconds and then fiU
slowly from below upward in thirty-five to sixty seconds, or longer in some
cases. The test is repeated and when the patient stands, the tourniquet is
released at once. If the veins quickly distend to their former tension from
above downward the patient is classified as Trendelenburg positive.

The Trendelenburg positive group comprises those cases in which the valve
function in the upper part of the great saphenous veins is deficient or absent,
thus permitting a reverse flow from the femoral vein into the saphenous vein
at the sapheno-femoral junction. This is the type of case most frequently
encountered. It is effectively treated by preHminary high ligation and di-
vision of the great saphenous vein, and separate ligation and division of all
the tributaries at the fossa ovalis. Injection therapy is carried out subse-
quent to the operation.

The Trendelenburg negative case is one in which the reverse flow from the
deep veins into the superficial veins takes place through one or more dilated
communicating veins described by McPheeters as blowouts. When the
Trendelenburg test is made in this group, the veins will fill rapidly when the
patient stands with tourniquet pressure maintained. If the varices in the

4 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB.

leg are extremely large, preliminary ligation or ligations should be performed
at the highest demonstrable point of back flow and aU other points of re-
verse flow below it. In such cases a high hgation and division of the great
saphenous veia are carried out as an added measmre of security. The
sources of back flow from the deep veins may be ascertained more accurately
by a segmental t5^e of Perthes test.

The Trendelenburg double group comprises those cases in which the back
flow takes place at the sapheno-femoral junction as well as through one or
more of the dilated communicating veins in the lower part of the limb.
Briefly, it is a combination of the positive and negative types of back flow,
and the treatment obviously is high hgation and division of the great saphe-
nous vein, and Ugations in the lower part of the limb wherever the back flow
can be demonstrated.

Trendelenburg nil cases are those with dilated veins in the presence of
competent or normal valves. The test is the same as for the Trendelenburg
positive type, except that when the tourniquet is released quickly, the veins
do not fiU from above downward. This is the early t3^pe of case frequently
seen with no reverse flow. These varices may be obhterated adequately by
injection of the sclerosing agent, and vein Hgation by surgical operation is
unnecessary.

In making the Trendelenburg test, the status of the short saphenous vein
must also be borne in mind. One frequently sees cases in which a reverse
or back flow takes place from the pophteal fossa. In these the same prin-
ciple of treatment is applied, namely, high hgation and division of the short
saphenous vein at its junction with the pophteal vein.

The competency of the valves also can be determined by the comparative
tourniquet test. The patient with varicose veins is instructed to walk about
40 feet without impediment to the lower extremities and without a tourni-
quet. If the varicosities disappear, the valves are competent and ligation
is unnecessary; this is comparable to the Trendelenburg nil test. Satis-
factory results can be obtained by injection alone. If after walking the
varicose veins do not disappear, a tourniquet is apphed just below the
sapheno-femoral junction, and the patient is instructed to walk again.
Should the varicose veins disappear it indicates that a back flow of blood is
coming only from the femoral vein at the sapheno-femoral junction; it is
comparable to the Trendelenburg positive test. Ligation of the greater
saphenous vein at the sapheno-femoral junction is indicated. If the vari-
cosities do not disappear with the tourniquet placed high on the thigh, the
tourniquet is reapphed at lower levels and the results are noted. A decrease
in size or pressure within the varicosities indicates the ehmination of a leak-
ing communicating vein from the deep to the superficial venous system.
Finally, the tourniquet is applied at a level where the varicosities will dis-

PIERFONT AND BRANTIGAN—USE OF SOTRADECOL 5

appear upon walking. Each level at which a change occurs upon appUcation
of the tourniquet indicates a leak from the deep system and a site where
ligation of the communicating vein and greater saphenous vein should be
done. Results thus obtained combine the Trendelenburg negative and
double tests. Occasionally one finds a patient in whom the tourniquet test
makes no change in the varicosities regardless of where it is placed. This
indicates innumerable leaks from the deep system and also presents an un-
favorable prognosis whether the varicosities are treated by hgation and in-
jection or by injection alone. On the other hand, either method will be tem-
porarily effective. A satisfactory obliteration of the veins can be obtained
by persistent treatment but there will be a recurrence of the varicosities.

A modified Perthes test was used to ascertain the patency of the deep
veins. An elastic compression bandage is appHed to the leg up to the knee,
and the patient is instructed to walk rapidly for ten minutes and then return.
If no discomfort is encountered, it may be assumed that the deep circulation
is free from blockage.

The presence of edema and enlargement of a limb should make one sus-
picious of deep circulatory venous insufficiency. Treatment of these indi-
viduals should be cautious and should lean more toward compression
measures with heavy well fitting elastic stockings.

Care should be exercised in using the injection therapy of veins in cases of
impaired circulation caused by peripheral arteriosclerosis and thromboangi-
tis obhterans. To test for this, the patient is placed in a reclining position
and both ankles and knees are exercised continuously for a few seconds.
If the feet become cold and pale, there is impaired circulation in the arteries
(9). The treatment of the varicosities must be approached with caution;
if such care is indicated, Hgation alone should be used. Sclerosing agents
with or without operation are contraindicated.

Except for especially large veins which were injected in a recHning position
with the veins empty, all veins were injected in the upright position by using
the safety cabinet (1). The injections were begun two weeks from the time
of operation and continued at weekly intervals until all veins were obht-
erated. The 3 per cent solution proved the most satisfactory dilution and
was used for all veins except the principal saphenous vein and the dilated
veins in the skin. It is evident that the principal saphenous vein with its
thick wall will withstand a stronger sclerosing agent than the ordinary vari-
cosity and therefore the 5 per cent solution was used. The thin walled di-
lated vein in the skin can be sclerosed adequately with the 1 per cent solution.
The amount of solution injected varied from 1 to 6 cc. The average number
of injections per patient was 4.66.

The results are demonstrated in Table I. The actual number of patients
differs from the total of the number of patients injected with the various

6 BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

solutions. This discrepancy is explained by the fact that many patients
received several different dilutions of sotradecol.

There were six hundred and eighty-six injections given to 147 patients.
No failures were noted so far as obhteration was concerned. In a few pa-
tients the sclerosing process took a little longer, since the thrombus which
formed was not as extensive as was expected.

TABLE I
Varicose Veins Injected with Sotradecol

No. of Injections

No. of Patients

Failures in Obliteration.

Sloughing

Cramps

Pain** .

Pigmefitation***

Skin Rashes

Systemic Reaction

CONCENTRATION— PEECENTAGE

4%*

436

686

147

26
2
3
3

* Four per cent sotradecol is no longer available.

** No specific note was made on most charts concerning pain. It is the feeling of the
authors that this was fully 50 per cent.

*** Not indicated on the charts, but it is felt by the authors that some degree of pig-
mentation was present in fully 50 per cent.

NOTE: Sotradecol was first used on April 4, 1944.

COMPLICATIONS

1. Sloughs. There were three sloughs in ninety-nine injections with the
1 per cent solution, an incidence of 3.0 per cent. All of these were in the
spider burst t3^pe of veins where the margin of safety from such an occurrence
is necessarily low. Seven sloughs occurred in four hundred and thirty-six
injections using the 3 per cent solution, an incidence of 1.6 per cent. There
was one slough in fifty-two injections using the 4 per cent solution, an in-
cidence of 1.9 per cent.* Two sloughs were seen in ninety-nine injections
using the 5 per cent solution, an incidence of 2.0 per cent. There was a total
of thirteen sloughs in six hundred and eighty-six injections, or an incidence
of 1 .89 per cent. The sloughs were all of a localized type and healed quickly.

2. Pain. There were only twenty-six instances in which pain was noted
on the charts in the six hundred and eighty-six injections, an actual incidence
of only 3.78 per cent. However, it was the opinion of both authors that fully
50 per cent of the patients complained of some degree of pain.

'■ The 4 per cent solution is no longer available.

PIERFONT AND BRANTIGAN—USE OF SOTRADECOL 7

3. Pigmentation. This was not indicated on most of the charts but here
again it was the feeUng of the authors that at least 50 per cent had some de-
gree of pigmentation in the area of injection. This is caused by the hemoly-
sis which occurs with the deposition of insoluble hemosiderin in the tissues.
It can be obviated somewhat by emptying the vein as much as possible just
prior to the injection of the sotradecol, either by elevating the leg or massag-
ing the vein.

4. Reactions. The reactions were sMght. None required any active treat-
ment nor were they fatal. All subsided rapidly of their own accord. There
were three skin rashes and four systemic reactions, a total of seven in six
hundred and eighty-six injections, an incidence of 1.02 per cent. The skin
rashes were hivelike in character. The systemic reactions consisted of head-
ache, nausea, and vomiting, coming on several hours after the injection.

5. Recurrence. It has been the feeling of the authors that the incidence of
recurrence cannot be computed because of the fact that one cannot distin-
guish new varices from recurrences. For this reason no estimate has been
compiled. However, in no instance has patency recurred in the greater
saphenous vein at the ankle where it can be definitely identified,

CONCLUSIONS

1 . Sotradecol in our opinion and from the results we have obtained appears
to be less toxic and more effective than other sclerosing agents available at
this time.

2. The availabiUty of sotradecol in varying dilutions furnishes an agent
better suited for use in varicose veins of varying size and thickness of wall.

3. A new and useful agent has in our opinion been added to the armamen-
tarium of the physician for the obhteration of varicosities.

BIBLIOGRAPHY

1. Bkantigan, O. C: Bull. School of Med., Univ. of Md., 27: 212, 1943.

2. Cooper, W. M.: Surg., Gynec, and Obst. 83: 647, 1946.

3. Dale, M. L.: J. A. M. A. 108: 718, 1937.

4. DeTakats, G.: J. A. M. A. 96: 1111, 1931.

5. Jensen, H. and Jahnke, P.: J. Am. Phar. Assoc, ed. 2 33: 362, 1944.

6. McPheeters, H. O. and Anderson, J. K.: Injection Treatment of Varicose Veins

and Hemorrhoids, ed. 2 rev., Philadelphia, F. A. Davis, Co., 1939.

7. OcHSNER, A. AND Mahorner, H. R.: Surgery 2: 889, 1937.

8. REmER, L.: Proc. Soc. Exp. Biol. 62: 49, 1946.

9. Samuels, S. S.: Peripheral Vascular Diseases, New York, Oxford University Press,

1943.
10. Shelley, H. J.: J. A. M. A. 112: 1792, 1939.

MIXED TUMORS OF THE SALIVARY GLANDS*!
MICHAEL L. DeVINCENTIS, M.D. and EDWARD S. McCABE, M.D.

BALTIMORE, MD.

The distinction of a benign and a malignant tumor is interesting both from
a theoretical and from a practical side, especially in regard to mixed tumors
of the saUvary glands. There is a tendency to restrict the term malignant
to tumors exhibiting certain features deleterious to the host. According to
Ewing (5) these are: (1) infiltrative growth; (2) local destruction; (3) re-
currence following operative removal; (4) metastases; (5) interference locally
with function; (6) general toxic action of absorbed tumor products.

In 1859 Billroth (2) described the tumors of the salivary glands so com-
pletely from the standpoint of surgical pathology that, with the exception of
the occasional occurrence of bone, no new feature has been added. He
characterized the tumors, which occurred most frequently in the parotid
glands, as painless, slow growing, often multiple, encapsulated, and hard or
soft depending on the relative amount of cartilaginous or mucoid stroma.

That the histogenesis is still not understood is evidenced by the persist-
ence of multiple theories of origin. Billroth (2) regarded these tumors as
myxoma; Virchow (14) as enchondroma and Volkmann (15) believed he had
demonstrated an endothelial origin. Hinsberg (8) in 1899 criticized the
mesench5nnal theory and assumed that the mixed tumors started from em-
bryonic rests of the parotid anlage, which develops as a bud-like invagina-
tion of the buccal epithelium. Elrompecker (9) thought mixed tumors were
varieties of basal cell carcinoma. Chevassu (3) believed the mixed tumors
arose from enclavement of the embryonal material of the branchial arches.
McFarland (11) accepted the theory with some reservations and based an ex-
planation of the histologic peculiarities on the number and character of
originally detached elements. All in all, each theory leaves something to be
desired. The epithelial theory has the most numerous adherents, but here
again the problem is: what is the origin of cells which can appear now as of
epithehal and again as of mesenchymal nature?

As far back as 1878 Marshall (12) recognized that some of the epithelial
cells of the neural crest in the head region went into the formation of mes-
enchyme. In 1918 Forman and Warren (6) confirmed this concept by show-
ing that in certain fishes and amphibians cartilage could be derived from
ectoderm. Thus a postulate arose that inclusion or misplacement of such
an ectodermal mesenchyme could give rise to tumors. The cells of these

* From the Department of Surgery, Mercy Hospital, Baltimore, Md.
t Received for publication April 23, 1948.

DEVINCENTIS AND McCABE—MIXED TUMORS 9

tumors failed to differentiate and either simulated the epithelial cells from
which they arose or differentiated along normal lines, forming myxoid, chon-
droid, connective tissue and sometimes bone. Hellwig (7), while studying
the intervertebral disc in human embryos histologically, was impressed with
the similarity in structure between the fetal disc and mixed tumors of the
salivary glands. He also pointed out that the cartilage, lacking a perichon-
drium, is not caused by the inclusion of a displaced anlage of cartilage, but
by secretory function of the epithelial cells. Now the notochord is derived
from ectoderm, and in its cranial portion extends as far forward as the buc-
copharyngeal membrane. As the oral pocket of Sessel develops, the noto-
chord remains for a time attached to its posterior wall and according to
Linck (10) even enters the pharyngeal membrane. This pharyngeal mem-
brane ruptures in the fourth week of embryonal life, but may persist oc-
casionally in the form of remnants, enclosing some cells of the chorda.
The parotid gland is the first to develop, approximately one week after rup-
ture of the pharyngeal membrane. It arises by invagination of buccal epi-
thelium at the former site of the pharyngeal membrane; and it is conceivable
that the remnants of one could be carried along by the budding gland to its
final location. At one stage in their development, the submaxillary glands
are in close proximity to the parotid glands. Finally it can be demonstrated
that the different appearances of mixed tumors correspond to stages of evo-
lution of the notochord.

CASE REPORT

The patient, a 77 year old white male, was admitted to Mercy Hospital July 2, 1945
with a chief complaint of painless swelling of the left cheek. This was of eight years dura-
tion and had become progressively larger. In the past year he had experienced some
ringing in his left ear and a slight impairment of hearing. The mass had now reached the
size of a small orange, (6 x 3.5 cm.). The physical examination revealed a well-preserved,
elderly, white male with a marked, rounded, purplish-blue swelling over the left side of
the face anteriorly and partially surrounding the left ear in the region of the parotid gland.
It was not tender and somewhat movable, although deeply attached. With a presumptive
diagnosis of mixed cell tumor of the left parotid gland undergoing carcinomatous degenera-
tion, an attempt was made to excise it in toto. The surgeon was far from satisfied, how-
ever, as he thought it impossible to do a complete excision and at the same time spare the
branches of the facial nerve.

The pathologic report was as follows: The section revealed a growth made
up of irregular glandular epithelium. The stroma was variable, in some
areas myxomatous, in others fibrous. This gave evidence of origin from a
mixed tumor. The overlying skin was infiltrated and extensive areas of
tumor necrosis were present in the depths. The diagnosis was: Mixed tumor
of the parotid gland with adenocarcinomatous change. Postoperatively he
was given a course of roentgen-ray therapy, 200 Ru, tliree times a week and

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Fig. 1 (Above). An adenomatous growth in the mixed tumor of the parotid gland,
characterized by dilatation of the alveoli. Note the fibromatous stroma. 100 X.

Fig. 2 (Below). An area showing typical carcinoma. Note the glandular pattern of the
growth and marked hjqDerplasia. 100 X.

DEVINCENTIS AND McCA BE— MIXED TUMORS 11

discharged July 26, 1945. There was a persistent discharge from the oper-
ative site and some residual damage of the facial nerve.

The patient was readmitted May 19, 1946 with a history of pain and deformity, fol-
lowing the crossing of his legs. During the previous two months he had been well except
for occasional pains in his legs. However, on physical examination he now appeared
emaciated, but in no acute distress. The blood pressure was 160 systolic over 90 diastolic,
with a pulse rate of 90. A systolic aortic murmur was heard, but there was no cardiac
enlargement. There was slight swelling and drainage in the region of the left cheek.
There was an S-shaped deformit}' in the middle of the left thigh, indicating a possible
fracture.

Roentgenography confirmed the diagnosis, but indicated that the fracture must be
pathologic. A Haynes splint was applied, and local irradiation was begun. Within a
short time callus was present. However, on palpation, some enlargement of the left hip
was noted. Roentgenograms revealed extensive destruction of the left ilium and the
upper part of the left ischium. The acid phosphatase was 1.3 units and the blood count
showed the patient to be somewhat anemic. The mass became fluctuant, and blood was
aspirated. The patient went downhill rapidly and died of a hypostatic pneumonia.

Post-mortem examination: The body was somewhat emaciated and on the
lateral surface of the left thigh there were four infected sinuses, which marked
the sites of pins which had been used for external fixation of the pathologic
fracture through the femur. Over the region of the left parotid gland there
was an ulcerated area measuring about 3 cm. in diameter, representing the
site from which the tumor of the parotid gland had previously been removed.

The body was opened in the routine manner and the organs of the thorax
and abdomen were in normal position. The pleural cavities contained a
very small amount of clear fluid and there were no adhesions. The lungs
were moderately edematous and there was no evidence of infarction. The
pulmonary vessels were patent. The coronary vessels were patent and the
aorta revealed moderate atheromatous plaque formation. The right kidney
revealed a slight degree of hydronephrosis ; the left kidney showed a markedly
dilated pelvis with marked injection of the papillae. The left ureter was
moderately dilated.

A tumor mass, measuring 12 x 10 x 6 cm. was found which occupied the
entire left iliac fossa. It was solid, though somewhat soft in consistency
and had apparently destroyed the entire ilium and a portion of the ischium.
The mass had displaced the left ureter medially and had partially occluded
it as a result of pressure. The cut surface of the tumor presented a whitish
mass with coarse fibrous trabeculations passing through its substance, giving
it a honeycombed appearance.

In the left femur, the tumor appeared to have invaded both the cortex
and the bone marrow and extended about 2 cm. distally and }~)roximally
from the site of the pathologic fracture.

Microscopic observations: Only the essential findings are taken from the
microscopic report.

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

%^M

fe^&:-

I.':.,..

F"iG. 3 (Above). Distinct alveolar patterns. The epithelial cells are columnar, and

hyperchromatic nuclei and mitotic figures are abundant. 430 X.

Fig. 4 (Below). Metastatic lesion to the ilium. Note the similarity of the pattern as

found in the original tumor. 100 X.

Fig. 5 (Above). The metastatic lesion invading the surrounding bone. 100 X.

Fig. 6 (Below). A metastatic lesion, showing the alveolar pattern and hyperchromatic

nuclei and mitotic figures. 430 X .

14 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB.

(a) Lungs: One of the branches of the pulmonary vein contained an organiz-
ing thrombus which was undergoing recanahzation. No metastases were
encountered, and there was an interstitial diffuse polymorphonuclear infil-
tration, with generalized edema.

(b) Spleen: The reticulum of the spleen was saturated with polymorphonu-
clears and plasma cells. There was rather marked passive congestion and
many phagocytic cells containing blood pigment were encountered. The
capillary walls were thickened and showed hyalin degeneration. There was
no infarction and no evidence of amyloid infiltration.

(d) Kidneys: The pelvic mucosa of the left kidney was edematous. The
mucosal surface was roughened and characterized by hyperplasia and
desquamation of epithelial cells. There was a deposition of exudate and
fibrin. There was also an infiltration of leukocytes extending to the corti-
cal zone, interstitial in character and having a tendency to form early focal
necrosis. Some of the conducting tubules contained cellular casts. Ex-
cept for cloudy swelling, the right kidney was essentially unimportant.

(e) Liver and other organs were unimportant except for cloudy swelling.

(f) Femur: There was extensive necrosis and the medullary portion of the
femur was saturated with exudate which in some sections was characterized
by proliferating fibroblasts and capillaries. The bone trabeculations were
fragmented and rough. No osteoblastic element was intact. The exudate,
together with the extensive necrosis, obscured the autolyzing tumor tissue.
The tumor cells were poorly preserved and in most instances only the cell
outlines remained for identification.

(g) Parotid: There was marked fibrosis, and an excess of scar tissue and colla-
gen interrupted by pools of necrotic tissue, constituted the general aspects.
Occasional islands of polyhedral shaped epithelial cells, which had a tend-
ency to form alveolar and glandular patterns, were seen. The cells were
hyperchromatic, and mitotic nuclei were quite numerous. The tumor
growth was greatly distorted by ulceration and fibrosis. Atrophic remnants
of salivary gland were also encountered in the scar tissue and fat.

(h) Ilium: Sections through the growth removed from the crest of the ilium
were composed of polyhedral shaped cells which had a tendency to form
alveolar and acinar patterns. Many of the alveoli were distended by clear
fluid. Many such foci of gland tissue were encountered, separated by bone
trabeculations and fibrous tissue. The cell nuclei were hyperchromatic and
mitotic figures were relatively numerous. The growth had many features in
common with the tumor removed from the irradiated ulceration in the region
of the parotid.
Final Anatomic Diagnosis: (1) Mixed tumor of the left parotid gland dis-

Fig. 7 (Above). A roentgenograph, showing extensive destruction of the left ilium and

upper part of the ischium.

Fig. 8 (Below). A roentgenograph, showing evidence of bone destruction at the site of the

pathologic fracture of the left femur.

16 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF MB.

torted by fibrosis and necrosis, presenting adenocarcinoma. (2) Metasta-
sis to the left ilium, perforating through the bone, filling the pelvic fossa,
and extending into the hip joint. (3) Metastasis to the left femur with
pathologic fracture and acute osteomyelitis, probably secondary to Hayne's
sphnting. (4) Hydronephrosis ■ and pyelonephritis, left. (5) Pulmonary
edema and hypostatic pneumonia. (6) Generalized cloudy swelling.

DISCUSSION

Mulhgan, (13) in 1943, reviewed the metastatic nature of mixed tumors
of the sahvary glands and pointed out that metastases were relatively un-
common considering the high rate of recurrence. Until that time only 8
cases with metastases to bone had been recorded.

The incidence of mixed cell tumor of salivary glands according to Schrei-
ner, et al. (14) is 1 per cent of all tumors. In a surv^ey of large hospitals in
Philadelphia, McFarland (8) found 2 cases per hospital per year. At Mercy
Hospital, Baltimore, 14 mixed cell tumors have been seen in the past ten
years. The duration of tumors followed at this hospital averaged four and
a half years.

In Ahlbom's (15) series, the average age was 43 years for benign tumors,
but a somewhat older age, 77 years, was found for the malignant tumors.
In the former series there was an even distribution between sexes. In the
present study, females were predominant in the ratio of 4 to 1. Moreover,
the malignant tumors were observed only in the male.

McFarland found that the tumors involved the three salivary glands in
the following percentages: parotid 93.5 per cent, submaxillary 6 per cent and
subhngual or palatal 0.5 per cent. At Mercy Hospital 92 per cent were in
the parotid gland with roughly equal distribution as to the side involved and
8 per cent were submaxillary, mainly left.

At Mayo Clinic Dockerty (16) was in agreement with others as to type
and frequency of occurrence. There are four types: Interstitial 72 per cent,
Glandular 18 per cent. Carcinoma 6 per cent and Sarcoma 4 per cent. As to
recurrence, the glandular type shows a 60 per cent rate of recurrence as
compared to 36 per cent for the interstitial type. Here, 92 per cent were
mixed tumors, adenomatous type, with one showing cystic degeneration.
The other 8 per cent were adenocarcinoma. As far as can be ascertained
there were 30 per cent recurrences.

The case reported shows the inadequacy of present treatment. Pain
means involvement of perineural lymphatics and would seem to indicate a
malignant or cylindroma type of lesion. Hence, wide block dissection plus
irradiation is the treatment of choice. The type can be confirmed by a
frozen section. In a case of pathologic fracture, roentgen-ray irradiation
was shown definitely to promote healing much more rapidly than in an ordi-
nary fracture of the same magnitude.

DEVINCENTIS AND McCABE— MIXED TUMORS 17

CONCLUSION

Here then is a brief summary of the known facts regarding mixed cell
tumors of the salivary glands with a case report of a primary adenocarcinoma
of the parotid gland with widespread and extensive metastases to bone.
A resvime of a theory on the origin of mixed cell tumors is presented. Yet
one wonders why, as a rule, they are seen so late in life. Here, too, a plea
is made for a more radical resection of the gland, sacrificing, if necessary^
some elements of the facial nerve in the hope that a cure may be attained.

BIBLIOGRAPHY

1. Ahlbom, H. E.: Mucous and Salivary Gland Tumors, Acta radio!., supp. 23, p. 1,

1935.

2. Bn^LROTH, T.: Virchows Arch. f. path. Anat. 17: 357, 1859.

3. Chevassu, M.: Rev, de Chir., Paris 41: 145, 1910.

4. DocKERTY, M. B. AND Mayo, C. W.: Primary Tumors of Submaxillary Gland with

Special Reference to Mixed Tumors, Surg., Gynec. & Obst. 74: 1033 (June), 1942.

5. EwiNG, J.: Neoplastic Diseases, 4th Ed. Philadelphia and London, W. B. Saunders,

1940, p. 48.

6. FoRMAN, J. AND Warren, J. H.: Ann. Surg. 47: 67, 1918.

7. Hellwig, C. a.: Mixed Tumors of Salivary Glands, Arch. Path. 40: 1 (July) 1945.

8. HiNSBERO, v.: Deutsche Ztschr. f. Chir. 51: 281, 1899.

9. Krompechee, E.: Beitr. z. path. Anat. u. z. allg. Path. 44: 51, 1908.

10. LiNCK, A.: Anat. Hefte 42: 605, 1911.

11. McFarland, J.: Am. J. M. Sc. 132: 804, 1926.

12. Marshall, A. M.: Quart. J. Micr. Soc. 18: 10, 1878.

13. Mulligan, R. M.: Metastases of Mixed Tumors of Salivary Glands, Arch. Path.

35: 357 (March), 1943.

14. ScHREiNER, B. F. and Mattick, W. L.: Am. J. Roentgenol. 21: 541, 1929.

15. VrRCHOw, R. : Die krankhaften Geschwulste, Berlin, A. Hirschwald, 1863, Vol. I,

p. 502.

16. VoLEMANN, R.: Deutsche Ztschr. f. Chir. 41: 107, 1895.

CHRONIC NEPHRITIS IN PREGNANCY WITH SPECIAL
REFERENCE TO THE DIAGNOSIS* f

L. CALVIN GAREIS, M.D.

BALTIMORE, MARYLAND

Toxemias of pregnancy have been recognized for a long time. The earli-
est recorded references are in the Hippocratic literature, where it is stated:
"convulsive attacks may be anticipated when the pregnant woman com-
plams of HEADACHE and DROWSINESS." At first the main differ-
entiation of toxemias from other causes of fits seemed to rest upon a history
of convulsions prior to gestation. Thomas Young in 1776 said: "If a woman
has had these fits before, there is less danger to be apprehended from them."
He believed that the pressure of the uterus on the iliac veins gave rise to
overdistention of the vessels of the brain and caused the fits; he advocated
venesection and prompt dehvery. "It is of interest to note that Leypold in
a foreign medical publication published an article in February 1946 advo-
cating blood letting (300-500 cc.) to reheve the heart, reduce the blood
pressure and free the blood and other tissues from accumulated water."

It is only a little over a century ago that statistics accumulated relative
to the incidence of toxemias. Edema and albuminuria began to be identified
with toxemias. It was not until the beginning of the twentieth century
that routine prenatal care was recognized as a necessity. It was found that
by regular examination of the pregnant woman, one could be forewarned
of the impending attack by the presence of edema, weight gain, elevation of
blood pressure and albuminuria. The study of these cases led to the recog-
nition of pre-eclampsia, eclampsia and other conditions which resembled
eclampsia. Among these were renal and vascular disease as complications
of pregnancy.

RENAL DISEASE IN PREGNANCY

Acute and chronic glomerulonephritis and nephrosis are rarely found in
association with pregnancy, the incidence being less than 0.1 per cent.
These conditions, however, may so closely resemble pre-eclampsia and
eclampsia that at times the correct diagnosis cannot be made until after
delivery.

Acute Glomerulonephritis: Acute nephritis may be defined as the occurrence
of protein, erythrocytes, casts and leucocytes in the urine of a previously
normal individual.

* From the Department of Obstetrics, School of Medicine, University of Maryland,
t Received for publication January 14, 1948.

GAREIS— CHRONIC NEPHRITIS IN PREGNANCY 19

In non-pregnant patients Murphy and Rastetler found: proteinuria in
100 per cent of the patients; edema in 57 per cent; hypertension in 40 per
cent, nitrogen retention in 44 per cent and uremia in 7 per cent. The dis-
order usually follows an infection which is streptococcal in origin and is
usually self-limiting. Complete recovery may take place in from three to
eighteen months. If abnormal urinary findings are present after two years,
the disease is then considered chronic by the internist. Retinal changes
are rarely seen.

Acute nephrosis and lipoid nephrosis are merely terms used to describe cases
of acute nephrosis without hypertension but with massive edema, marked
proteinuria over a long period of time, slight cyhndruria and no hematuria.
Characteristic findings in the blood are : decrease in the hemoglobin, serum
protein content of less than 5 per cent, and albumin globulin ration of less
than 1, httle or no nitrogen retention, and marked increase in cholesterol
and total lipoids. This syndrome is often called albuminuria of pregnancy
and is considered an atypical form of chronic glomerulonephritis.
Chronic Nephritis: The presence of edema, hypertension, proteinuria and
leucocytes in the urine before the twenty-fourth week of pregnancy always
suggests kidney disease. Patients with hypertension and/ or renal disease
comprise about one-half of the toxemias of pregnancy. Patients with
chronic glomerulonephritis, nephrosis, pyelonephritis and other rare renal
diseases make up less than 2 per cent. The rest are the hypertensive dis-
ease group.

If signs of renal disease with acute nephritis are present after two years,
the condition may be called chronic nephritis. These patients rarely go to
term and usually abort between the twelfth and twenty-sixth week, when
marked infarction, hematoma or premature separation of the placenta are
the only findings.

Nephrosclerosis: An arteriosclerotic disease of the kidneys, hypertensive
disease, usually causes death before the kidneys are markedly aft'ected. In
hypertensive disease, there is normal urea clearance. In nephrosclerosis,
renal impairment (clearance 20-30 per cent) may be marked without pro-
teinuria. Changes in the retina are common; the non-protein nitrogen of
the blood is rarely elevated until late in the disease.

THE DIAGNOSIS OF CHRONIC NEPHRITIS

The diagnosis of chronic nephritis is not difficult, if the proper tests are
used to evaluate renal damage. Many cases diagnosed as pre-eclampsia
are really chronic nephritis. Bell (1) points out that in 37 cases of chronic
nephritis in pregnancy, 9 had symptoms corresponding to eclampsia or pre-
eclampsia. 'Tt is important to make this differentiation between pre-
eclampsia and renal disease, since pre-eclampsia demands immediate and

20 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

enthusiastic treatment but chronic nephritic disease can be treated more
conservatively." The diagnostic features of chronic nephritis are:

1. A history of acute nephritis or of proteinuria prior to pregnancy.

2. Usual occurrence in patients under 30 years of age.

3. Proteinuria 1-15 gms. daily (constantly).

4. Urea clearance decrease less than 50 per cent of normal.

5. Blood non-protein nitrogen normal or slightly increased.

6. Blood pressure normal or moderately elevated.

7. Constant low specific gravity of urine.

8. Narrowing of arteries of the retina.

9. Kidney function tests: urea clearance, dilution and concentration
tests, and phenol suKonphthalein all markedly decreased.

10. Uric acid markedly elevated.

A REVIEW OF TEN CASES OF CHRONIC NEPHRITIS

Ten cases of chronic nephritis in pregnancy which have occurred at the
University of Maryland Hospital in the past three years were reviewed and
the findings recorded. It has been previously stated that one of the most
important points in the diagnosis of chronic nephritis in pregnancy is a his-
tory of renal disease prior to pregnancy. A history of albuminuria and
acture febrile disease, such as scarlet fever or other streptococcal disease,
is common.

Of the ten cases reviewed:
History: Three had kidney trouble (albuminuria) prior to pregnancy; 2 had
a history of albuminuria and blood pressure elevation with a previous preg-
nancy; 1 had a history of frequent streptococcus sore throat; 4 had no pre-
vious relevant history.

Prenatal Symptoms: Prenatal symptoms of chronic nephritis are usually
described as headache, spots before the eyes, dizzy spells and gastric dis-
turbances long before such symptoms are seen in pre-eclampsia. Of the 10
cases, 6 gave a history of headache and dizzy speUs. One had convulsions,
but this patient had hypertensive disease also and should probably be classed
as nephrosclerotic.

In chronic nephritis blood pressure is usually only moderately elevated.
In the cases reviewed, the average blood pressure was 140 systolic over 90
diastolic except in 1 patient with a pressure of 220 systolic over 120 diastolic.
This may have been nephrosclerosis.

Edema is not an outstanding feature of nephritis in the chronic state and
when found, it is usually mild. Three cases showed one plus edema, 1
showed three plus edema.

Chronic nephritis in pregnancy is more common under the age of 30. Of
the patients under discussion most were young women, 7 under 21, 1 23,
1 28 and 1 38.

GAREIS— CHRONIC NEPHRITIS IN PREGNANCY 21

DURATION or PREGNANCY

Brown, Lynn and Anderson (2) in 1946 investigated the relationship
between the toxemias of pregnancy and prematurity. They reviewed 1300
cases at the Cincinnati General Hospital. They found that normally pre-
maturity occurred in 5 per cent of the cases. In toxemias they found the
occurrence to be as follows: mild toxemia, 7 per cent; severe toxemia, 17 per
cent; eclamptic toxemia, 38 per cent. They found that 18 per cent of
toxemia patients require early termination of pregnancy, and that there is
little difference between white and colored patients.

The durations of pregnancy in the cases here reviewed were: 2 full term
living children (1 induced and scalp clamp apphed) ; 1 delivered at 36 weeks
(membranes ruptured and labor induced) ; 3 delivered at 34 weeks, 1 living
child, 1 dead child, 1 section^iving child; 1 patient dehvered a hving child
at 31 weeks; 1 dehvered a stillborn child after medical induction at 30 weeks;
2 aborted spontaneously at 24 and 28 weeks.

It would seem from the work of Brown, Lynn and Anderson (2) that the
more severe the toxemia, the more chance of premature labor. Apparently
there is very Httle point in carrying a patient with chronic nephritis more
than 34 weeks. The best procedure seems to be delivery as soon as possible
after viabiHty is reached.

TYPE OF DELIVERY

Most authorities now agree that early delivery by the most expedient
means is the choice of treatment in chronic nephritis. If the cervix is favor-
able, rupture of the membranes and medical induction are advised; if not,
cesarean section and sterilization are preferable. Of the 10 cases herewith
reported, 6 delivered spontaneously, 3 had amniorrhexis, and of these 2 had
a scalp clamp applied; 1 was sectioned and sterilized; 1 was sterilized post
partum.

COMPLICATIONS

Patients with renal disease are prone to infection. Of the 10 cases, 6
showed some form of infection. One wound infection followed cesarean
section. Three had endometritis and subinvolution of the uterus. One
had infection of the perineum and 1 had pulmonary infarct and pleurisy. In
1 case there was postpartum hemorrhage.

RENAL FUNCTION TESTS

Patients with chronic nephritis show a marked decrease in kidney function.
Bell (1) states that at least three different tests should be made. One test
alone is of Httle or no value.

Phenolsulfonphthalein: This is commonly used because of its simplicity,
but is of small value unless kidney impairment is marked. Four cases

22 BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

showed less than 60 per cent of the dye returned, 1 as Kttle as 30 per cent.
Urea clearance test: This must show a consistent value of less than 50 per
cent to be of prognostic value. Dieckmann states that if urea clearance
shows less than 50 per cent consistently (three tests), kidney disease is
present.

Six cases showed less than 50 per cent and 1 of the 6 showed as little as
18 per cent postpartum. One showed 76 per cent; 1 showed 80 per cent.
In 2, tests were not done.

Dilution and Concentration Test: In chronic kidney disease, the urine is
characteristically of low specific gravity. All but 2 cases studied showed
a low specific gravity and did not concentrate over 1010. One case con-
centrated to 1018 and 1 to 1016 but not consistently. Proteinuria is only
suggestive of nephritis, being seen in cystitis, pyelitis, nephrosis and other
t3^es of renal disease. Dieckmann states that normally the same amount
of protein is excreted in pregnancy as in the non-pregnant state. More
than 5 gms. daily in the urine for more than ten days indicates nephritis
or nephrosis. This long period of spiU rarely occurs in pre-eclampsia and
is indicative of renal damage.

URINARY FENDENGS

All cases showed from a trace to four plus proteinuria, 5 showed casts, all
showed occasional red and white blood cells. The presence of casts is only
suggestive, and they may or may not be found. Hematuria, if present for
a week or longer, is evidence of acute nephritis.

BLOOD CHEMISTRY

In blood chemistry, the following findings are significant:

Sugar — low average 58 mgm. per cent, high 78 mgm. per cent, low 41
mgm. per cent.

Chlorides — (done on three patients), 300-400 mgm. per cent.

Carbon dioxide — (done on five patients), 35-55 vol. per cent.

Total protein — varied from 5.75 to 7 mgm. per cent.

The albumin globuhn ratio reversed in only 3 cases. The uric acid deter-
mination seemed to be the most valuable test. Its elevation varied with the
severity of the disease — early values were low, late ones elevated. The low
was 3.3 mgm. per cent, the high 8.8 per cent.

The m-ea nitrogen does not seem to be of diagnostic value in chronic
nephritis. It is elevated, but not consistently so, late in the disease when
other signs such as uremia are evident. A low of 11 mgm. per cent, a high
of 29 mgm. per cent and an average of 20 mgm. per cent may be considered
a criterion. Only 1 case showed an anemia with 60 per cent hemoglobin.

Post-partum blood pressure usually returns to pre-partum levels or re-
mains the same in chronic nephritis.

GAREIS— CHRONIC NEPHRITIS IN PREGNANCY 23

In these cases, the post-partum blood pressure averages 120 systolic over
80 diastolic; the hypertensive case averaged 140 systolic over 100 diastoHc.

Six cases had intravenous pyelograms done; all showed dilation of kidney,
pelvis and ureters greater than normal.

EYE GROUNDS

All cases showed increased Hght streak and narrowing of the arteries.
One case, that of nephrosclerosis, showed retinopathy. In this connection
the work of Hollum (8) on the study of eyegrounds in toxemia is of interest.

Hollum (8) claims that the frequency and degree of eyeground changes
more closely follow the severity of the hypertension and thus of the toxemia
than any other single laboratory or clinical sign. The one outstanding and
consistently rehable change observed in the eyegrounds was the degree of
general and localized spastic constriction of the retinal arterioles.

Hollum (8) appeals to the obstetrician to do his own ophthalmoscopic
work. During the course of severe and moderately severe toxemias of preg-
nancy, the most information is gained from the eyegrounds by making
examinations daily or every few days. The first change noted in the normal
retinal arterioles during a toxemia of pregnancy is constriction of the lumen
of the arteriole. The arteriole constriction is proved to be spastic in nature
when the degree and location can be seen to vary on subsequent examination.
Many patients after delivery with normal blood pressure show no more
constriction. The vessels have resumed normal caliber and ratio.

For convenience in description, the following classification of retinal
arteriolar spasm in toxemia of pregnancy is suggested. This classification
is based on the degree of arteriolar spasm, and usually indicates the severity
and duration of the toxemia.

Grade I: The spasms are localized in nature and may be limited to one or
more points. They are usually seen in the proximal portion of the arterioles.
The general diameter ratio of vein to arteriole is the normal one of 3 to 2 or
there may be a slight increase in this ratio. Blood pressure before deHvery
is below 150 systolic over 100 diastolic.

Grade II: The arterioles show a generalized constriction so that the diameter
ratio of vein to arterioles is 2 to 1. Usually there are also localized con-
strictions of the arterioles. Blood pressure varies from 150 systoUc over
100 diastolic to 175 systolic over 125 diastolic.

Grade III: The degree of generalized arteriolar constriction has increased
until the diameter ratio of vein to arterioles is 3 to 1. Fine localized con-
strictions are present, but hard to identify. Blood pressure is 175 systolic
over 125 diastolic or more.

Grade IV: The diameter ratio is 3 to 1 or more, and there is some degree of
retinopathy. As the retinal arterioles become more and more constricted,
there are signs of retinal ischemia, such as edema of the retina, hemorrhages

24 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

and exudates. Edema of the retina is usually the first sign of its involve-
ment. The earlier in pregnancy these toxic signs develop in the eyegrounds,
the more serious the prognosis. If retinopathy appears before the twenty-
eighth week, there is only a 25 per cent chance of the patient's giving birth
to a live baby, even if the pregnancy is allowed to go to the period of via-
bility.

ADDIS COUNT

One other test that is not used in the diagnosis of toxemias in the clinic
of the University of Maryland has proved to be of value. Addis has shown
the urinary sediment of normal subjects contains an average number of casts,
erythrocytes, leucocytes and epithelial cells per twenty-four hours excretion.
Elden and Cooney (7) have examined the urinary sediment in normal preg-
nant and toxemic patients with the Addis technique, with the following
results:

1. The number of formed elements in the urinary sediment is slightly in-
creased in normal pregnant patients.

2. Patients with mild pre-eclampsia show Httle change from normal.

3. Patients with acute glomerulonephritis show a marked increase.

4. Those with severe pre-eclampsia and eclampsia show a tremendous
increase, indicating a renal lesion.

Ohguria may be a contributing factor, and when diuresis starts, the count
goes down.

CONCLUSION

In conclusion the following statements may be in order:
Whenever possible renal disease should be differentiated from other tox-
emias of pregnancy by:

1. Accurate history.

2. Repeated renal function tests, using at least two of the known tests
and repeating these at least twice.

3. The making of a complete blood chemistry, repeated frequently to
follow the course of the disease with particular emphasis on the uric acid
findings.

4. Repeated eye ground examinations, daily or every other day. The
pupils should be dilated, and the examination done by the obstetrician.

5. Quantitative proteinuria examination of the urine.

6. The use of the Addis count.

Chronic nephritis is the one compUcation of pregnancy which is most
often confused with eclampsia and pre-eclampsia. Most authorities agree
that it is useless to carry a patient with chronic nephritis past the thirty-
fourth week, and pregnancy should be terminated by the most expedient
means at this time.

GAREIS— CHRONIC NEPHRITIS IN PREGNANCY 25

BIBLIOGRAPHY

1. Bell, E. T.: Renal Disease, Philadelphia, Lea & Febiger, 1946.

2. Brown, E. W., Lynn, R. A. and Anderson, N. A. : Causes of Prematurity, Am. J. Dis.

ChUd. 72: 189 (Aug.) 1946.

3. Chesley, L. C. and Chesley, E. R.: The Cold Pressor Test in Pregnancy, Surg.,

Gynec, & Obstet. 69: 435, 1939.

4. DiECKMANN, William: The toxemia of Pregnancy, St. Louis, C. V. Mosby Co., 1941.

5. DiECKMANN, William and Kramer, S.: Proteinuria in the Toxemias of Pregnancy,

Am. J. Obstet. & Gynec. 47: 285, 1944.

6. Earle, D. p., Taggart, J. and Shannon, J. A.: Glomerulonephritis, A Survey of the

Fimctional Organization of the Kidney in Various Stages of Diffuse Glomerulone-
phritis, J. Clin. Investigation 23: 119, 1944.

7. Elden, C. a. and Cooney, J. W.: Addis Sediment Count and Blood Urea Clearance

Test in Normal Pregnant Women, J. Clin. Investigation 14: 889, 1935.

8. HoLLUM, Alton V.: Retinal Arteriole in the H)^ertensions of Pregnancy, Tr. Am.

Opth. Soc. 43: 585, 1945.

EARLY DIAGNOSIS OF SLIPPING OF THE UPPER FEMORAL

EPIPHYSIS*t

ROBERT B. MEARNS, M.D., CM.

BALTIMORE, MD.

Slipping of the upper femoral epiphysis is a change in the relation of the
neck of the femur to the femoral head. This occurs at the junction of the
actively growing adolescent cartilage with the calcified bone of the neck of
the femur, commonly called the epiphyseal plate. This junction is the weak-
est part of the adolescent upper femur. A fracture of the neck occurs in
the adult, but a slipping of the epiphysis in the child. There has been noth-
ing new in the literature as regards etiology. In the majority of cases, the
epiphyseal junction is thought to be unusually soft and malleable and there-
fore less secure. This softening is believed to be the result of a hormonal
imbalance or in rare cases of renal rickets.

In the less frequent, truly traumatic displacement of the head in relation
to the femoral neck, the onset is brought about only by severe trauma;
the epiphyseal displacement is sudden, severe, and somewhat similar to a
fracture of the femoral neck in the adult. The majority of cases present no
such picture. The slipping is gradual and progressive. The t5^ical case
would be an adolescent boy who is obese or perhaps a true Froelich type.
He develops pain in the hip on activity which may subside with a few days
rest. At this stage there is a movement of the femoral head backward in
relation to the femoral neck. On the resumption of activity, there may be
a series of minor slips, first in the antiversional or horizontal plane and finally
in the vertical plane until eventually there is complete displacement. A
slight degree of slipping may often be converted to a severe or even complete
displacement by some sudden, mild trauma. This progression of slipping
may occur over a period of a few weeks, months, or even years. Of course,
as the displacement increases and usually after each superimposed slip, there
is an increase of pain, spasm, and limp and a decrease in motion range. In
a few cases, there will be a bilateral slipping.

A recent review of the cases of epiphyseal slipping admitted to Keman
Hospital in the past ten years revealed 25 cases with 30 hips involved. The
average time since admission is forty-seven months. Table 1 reveals the
points of general interest in this condition. The degree of success of treat-
ment as well as choice of it depends on two factors: first, the amount of slip,
and second, the relative mobility of the epiphysis in relation to the femoral

* From the Department of Orthopedic Surgery, Keman Hospital, Baltimore, Maryland.
t Received for publication April 30, 1948.

MEARNS— EPIPHYSEAL DISPLACEMENT

neck at the time of treatment. The 25 cases mentioned in this article were
divided into three groups on the basis of the degree of displacement as shown
by roentgenographic examination on admission to the hospital. Those
classed as minimal presented no vertical displacement and less than 1 cm.
of antiversional shift. The moderate cases were those with 1 cm. or more
of antiversional slip but with slight or no vertical shift. The third group
comprised the severe displacements showing obvious coxa-vara.

Results classed as good are those which present no pain or limp and a
range of motion that does not in any way restrict normal activity. The
fair results are those with no pain and only a mild limp but with a limitation

TABLE I

Total Cases

Total Hips Involved .

Left Hip

Right Hip

Both Hips

Male...
Female .

White..
Colored .

19(76%)
6(24%)

19
6

Average Age At Onset of Symptoms 13 .5 years

Average Time since Admission 3.9 years

Average Duration of Symptoms 8.5 months

History of Injury (often mild) 11 cases (44%)

Obese on Admission Physical Examination 21 cases

TABLE II

End Results Based on Degree of Displacement

Minimal Slip .
Moderate Slip
Severe Slip . . .

CASES

HIPS

GOOD

FAIR

of range of motion great enough to prevent participation in sports requiring
running. The poor results have pain on exertion or severe limitation of
motion and shortening.

Table 2 records the minimal slips. The end results were uniformly good
in the 6 cases. The results of the moderate slipping shown in this table were
either fair or good, but the group of severe slips in this series shows a
discouraging end result regardless of treatment used. Many of those with
moderate or severe slips may be expected to develop marked osteo-arthritic
changes in the fourth or fifth decade.

Results are so uniformly excellent when treatment is instituted earl}' while
the slip is still minimal, that every effort should be made toward early diag-

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Fig. 1. A minimal slip of the left hip. The admission roentgenographs show the difficulty
of diagnosis in the anterior-posterior view.

M EARNS— EPIPHYSEAL DISPLACEMENT

nosis and the early prevention of weight bearing. Four of the 6 minimal
slips were admitted in the past two years, which suggests that there has been
improvement in diagnosis. None the less, in this series, 14 of the 25 case
histories revealed a delay in hospitalization varying from a few days to sev-
eral months after the patient first sought medical advice because of hip pain.

Fig. 2. An anterior-posterior view, six months later, of the case shown in Fig. 1.

CASE HISTORIES

(Examples of Delayed Hospitalization)

Case j^5: An obese white boy aged 14| years had intermittent pain in the left hip of
eleven months duration. Roentgenographs of the hip were made at another hospital
nine months prior to admission to the Kernan Hospital. He was admitted with a moder-
ately severe unilateral slip. In the meantime he had been treated for flat feet.
Case j^6: An obese 15 year old white boy was admitted to Kernan Hospital with bi-
lateral hip pain. More than a year before admission he had pain in the right hi[) and be-
cause of this was seen by a private physician who made roentgenographic examinations
of the hip. Weight bearing was not discontinued. Three weeks before admission to
Kernan Hosjjital, there was a sudden exacerbation of jmin in the right hi]) following mild
trauma. (One can guess that at the time of the onset of hip pain a year before, (he epi-
physeal displacement was in the minimal stage but was not diagnosed, in sj^ite of the roent-
genographic examination. Three weeks before admission there must have occurred a
superimposed additional slip.) When admitted to the hospital, he had a severe bilateral
displacement.

30 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB.

Fig. 3. A minimal slipping of the left hip. The diagnosis is more obvious in the lateral

view.

MEARNS— EPIPHYSEAL DISPLACEMENT

Fig. 4. A moderately severe slipping of the right hip.

Fig. 5 (Above). The case shown in Fig. 4 two years later.
Fig. 6 (Below). A severe slip of the right hip.
32

MEA RNS—EPIPH YSEA L DISPLA CEMENT

Case §7: An obese 12| year old female was undergoing metabolic studies in a hospital
outpatient clinic. She had a history of pain in the left hip of four months duration. One
month later she was seen in the orthopedic clinic, where a diagnosis of minimal slip of the
left capital epiphysis was made. Fortunately in this case progression to a severe slip
did not occur in the month long interval of continued weight bearing.
Case # 15: An obese 15 year old colored bo}'-, who had complained of hip pain for four
months, sought treatment in the emergency room of a local hospital because of a sudden
increase in pain. He was told to return the next day for roentgenographs but was again

Fig. 7. The case shown in Fig. 6 two years later, showing marked osteo-arthritis.

sent home. He was seen in the orthopedic clinic three days later and immediately hos-
pitalized with a complete unilateral displacement of the epiphysis. Eight years later, this
boy has an ankj'losed hip.

Any obese child, 10 to 15 years of age, with hip pain, should be considered
a possible candidate for displacement of the upper femoral epiphysis. The
average age is 13.5 years. The age for girls is about a year less than for
boys. The condition is somewhat more common in boys. Body type is of
importance, since the majority, but not all, will be obese approaching a Froe-
lich type. The symptoms are intermittent hip pain, often referred to the

34 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

knee, sometimes relieved by periods of non-weight bearing. In the minimal
slips, the earliest limitation of motion will be a mild restriction of internal
rotation. There may be a varying degree of protective muscle spasm.
The most important aid in diagnosis is roentgenographic examination. As
Watson- Jones has aptly written, "A lateral radiograph must be taken, and
without this a suspected epiphyseal slipping has not been excluded." It
has been well shown that the so-called widening of the epiphyseal line is the
result of antiversion which projected in the roentgenograph gives the illus-
tration of widening. The degree of slip in the sagittal plane cannot be de-
termined by antero-posterior roentgenographs.

A discussion of treatment will not be included. It is sufficient to say that
anything which will prevent further slipping is the aim; and of course the
immediate stoppage of all weight bearing is most important. It is well to
reahze that where there is unilateral slipping, there is always a possibility of
a similar slip occurring in the sound hip. Such instances have occurred in
hospitalized patients. A vigorous turn in bed may be enough to displace
the epiphysis in the opposite hip.

In conclusion the results obtained in upper femoral epiphyseal slipping are
uniformly good when the diagnosis is made in the minimal slipping stage.
Lateral view roentgenographs are essential for sure diagnosis. A study of
25 cases admitted to Kernan Hospital indicates that there is often a consid-
erable delay in diagnosis and hospitalization.

PHARYNGEAL BURSITIS
A Case Report*!

FREDERICK T. KYPER, M.D. and RICHARD J. CROSS, M.D.

BALTIMORE, MARYLAND

In 1886 Tomwald of Danzig published a series of cases in which he de-
scribed a certain t3^e of bursae occurring in the nasopharynx. Diseases of
these bursae produced many systemic symptoms. Other writers have since
described various cysts and abscesses in the nasopharynx which have been
associated with Tomwald's bursae and have erroneously been classified as
Tomwald's disease. Strictly speaking, however, Tomwald's disease applies
only to pharyngeal bursae and not to cysts or abscesses arising from con-
ditions of the adenoid.

Cysts and abscesses in the nasopharynx may be the result of inflammation
of the median recess and furrows of the adenoid (these are acquired) or
they may follow inflammation of the pharyngeal or Tomwald's bursae (these
are secondary to a congenital abnormality of the nasopharynx).

Dorrance (1) gives perhaps the best description of the pharyngeal bursae.
He states, "The term bursae identifies a closed sac lined with endothelium.
While the so-called bursae pharyngea is not a closed sac nor of mesodermic
origin, long usage justifies the application of the term. The term bursa
pharyngea designates a sac-like depression in the posterior wall of the naso-
pharynx just above the uppermost fibers of the superior constrictor muscle
and usually extends upward and backward towards the occipital bone which
it sometimes reaches with its apex. It is a well marked structure in the
human embryo, although it seems to be rare as a distinct structure in the
adult."

After much speculation and study, investigators have reached the follow-
ing conclusions about the pharyngeal bursa: (1) It does not develop from
either Seessel's pocket or Rathke's pouch; (2) It is an independent stmcture
in itself and is not the median recess of the adenoid; (3) The pharjoigeal
bursae occurs not infrequently in man during embryonal life and takes its
origin from adhesions of the notocord to the pharyngeal entoderm; (4) This
bursa in adults probably represents persistence of the embryonal bursae
and, therefore, can be the seat of inflammation and cyst formation.

Similarly abscesses or cystic formation in the nasopharynx may also occur
as a result of inflammation of the median recess of the adenoid. As a re-

* From the Department of Rhinology, School of Medicine, University of Maryland,
t Read before the Otolar3'ngological Section of the Baltimore Citj' Medical Society,
January 26, 1948.

36 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

suit of inflammation, the median recess becomes occluded; secretions and
cellular material accimaulate, and a cyst or abscess may develop. In these
cases the cyst or abscess is superficial and may easily be opened with a probe
On the other hand, when the trouble lies in the bursae pharyngea, a probe
cannot be made to enter the cavity, as the mucous membrane of the naso-
pharynx is too resistant. In this circumstance a knife is necessary.

From a clinical standpoint Woodward (3) has classified the two conditions
as follows: "Cysts which were definitely surrounded by adenoid tissue and
where cavities could be entered by separating the folds with a probe were
classified as retention cysts of the adenoid. Cysts with a smooth surface
without evidence of adenoid folds are regarded as originating in the bursa."

Occurrence: Both conditions are apt to occur in young adults. The
pharyngeal bursitis is likely to be found in patients who have had their ade-
noids removed, since it would probably be overlooked in a person with hyper-
plastic adenoids. The other condition would be simpler to diagnose because
the cavity is surrounded by adenoid tissue.

Symptomatology: Since both conditions are so closely related as to anatomic
location and similarity in pathogenesis, the symptomatology is for all prac-
tical purposes identical. The majority of patients will present one set of
symptoms when the cavity is open and discharging pus, and another set of
symptoms when the cavity is closed.

In the former the patients present post-nasal d,ischarge, frequent colds,
coughing, sneezing, hoarseness, hawking and occasionally bleeding. When
the cavity is closed, patients have pain in various parts of the head, a nasal
speech, sore throat, nasal obstruction and cervical adenopathy.

The majority of patients will at one time or another exhibit both types of
symptoms, depending on whether the cavity is open or closed at that par-
ticular time.

The most constant symptom is headache, similar to that associated with
sphenoid sinusitis. With some cases of pharyngeal bursitis, one small area
on the neck below the occipital bone will be painful.

Any type of sinusitis may be present to complicate the other aspects.
The S5Tiiptoms referable to nasopharyngeal disease may be meagre, but sys-
tematic conditions may occur as a result of a focus of infection in the naso-
pharynx. Various reflex nervous symptoms may be present.

Diagnosis: The nasopharyngoscope is of doubtful value because its blind
spot may miss the diseased area. Posterior rhinoscopy is the most impor-
tant means of making a diagnosis. One sees a swelling in the nasopharynx
which may be either grey, red or polypoid in appearance. Sometimes a
flattening out of the normal contour of the nasopharynx is significant. If
the cavity is draming, a stream of thick pus wUl be seen oozing out of a slit-
like opening. Cultures of the purulent material will normally show the
common organisms that inhabit the oropharynx. In cases of abscesses re-

KYPER AND CROSS— PHARYNGEAL BURSITIS 37

suiting from inflammation and blockage of the median recess of the adenoid,
a probe may be inserted and the contents of the cavity expressed.

Treatment: In cases where abscesses or cysts are caused by disease of the
adenoid, a probe can be inserted to break down the adhesions, and the cavity
may be opened. If the adenoid tissue is atrophic, the walls of the cavity will
collapse when the abscess is drained and obliterate the cavity, thus curing
the condition. However, if a large amount of adenoid tissue is present, this
must be removed and the cavity cauterized with a chemical or electrocautery.

When the cyst or abscess lies in the pharyngeal bursae, the surgical re-
moval of the anterior wall of the cavity with a punch forceps is necessary,
and the walls of the cavity must be cauterized. This may be done by plac-
ing the forceps through the nose. Inspection is carried out with the Yank-
auer nasopharyngeal speculum or mirror. Penicillin and sulfonamides are
given only as an adjunct to surgery.

CASE REPORT

Miss P. M., a student nurse, was admitted to the hospital, October 14, 1947 with a
chief complaint of post-nasal drip, fetid breath, chronic sore throat and frequent headaches
of eight months' duration. The illness began about one and a half years before, when
the patient developed a septic sore throat. Since then she had frequent sore throats
and a post-nasal discharge. For the previous eight months symptoms became worse,
and the patient had a continuous sore throat. About two months before admission, she
developed a severe cold which persisted with a purulent nasal discharge. The patient
was sent to the authors by the student health physician. At that time she had a profuse
mucopurulent discharge from both middle meati. The anterior tips of both middle turb-
inates were injected and enlarged and the entire nasal mucosa was inflamed. A marked
purulent post-nasal discharge was present, and the pharynx was inflamed. The tonsils
were cleanly removed. There was mild to moderate tenderness over the frontal, maxil-
lary and anterior ethmoid sinuses. Transillumination was diminished in both frontal
and maxillary sinuses. A diagnosis of pansinusitis was made. The patient was treated
with a vasoconstrictor, chemotherapy and mild suction. Under this treatment the si-
nusitis cleared, but the post-nasal discharge persisted unaltered. At this time another
condition was suspected. Posterior rhinoscopy showed a rounded, inflamed mass high
up in the nasopharynx in the middle of the epipharyngeal wall. Purulent material was
oozing from a small opening. There were no visible signs of adenoids around this mass.
A tentative diagnosis of Tomwald's disease was made. It was decided that by daily
cleansing of the nasopharynx with a mild antiseptic, plus deep roentgen-ray therapy, the
patient might be relieved of her difficulties. She was seen by the authors every day and
her nasopharynx was gently sprayed with Dobell's solution and the purulent material
removed with a swab. This procedure was continued until the course of deep radiation
was completed. At this time the therapy was evaluated and found to be unsuccessful.
The patient still had the profuse purulent post-nasal discharge and the pharyngitis was
unimproved. It was then decided to hospitalize her and excise the mass.

A physical examination on admission revealed the following relevant data:

Nose: Anterior rhinoscopy yielded no evidence of any lesion. There were no signs of
pansinusitis and no tenderness over the sinuses. Both the frontal and maxillary sinuses
transilluminated well. The mucous membrane was normal.

Throat: A profuse post-nasal discharge was present with a chronically inflamed phar\-nx.

38 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.

The results of posterior rhinoscopy were the same as those at the first examination. A
few small cervical glands were palpated in the neck. The impression was of Tornwald's
bursitis.

Laboratory Findings: Urine — normal. Serologic test for syphilis — negative. Hemo-
globin— 89 per cent (12.8 gm.) Sedimentation Rate — 10 mm. White blood count —
11,800. Filament — 79; non-filament — 0; lymphocytes — 11; monocytes — 10; esophino-
phils — 0; basophils — 0. Urea Nitrogen — 14 mgm. f>er cent; blood sugar — 71 mgm. per
cent.

Operation: The patient was taken to the operating room and under intravenous sodium
pentothal, a Davis mouth gag was inserted. An attempt was made to remove part of
the wall of the bursa by means of a biopsy forceps. However, because of the high position
of the bursa in the nasopharynx, this procedure was imsuccessful. An adenotome was then
inserted into the nasopharynx above the bursa, and under a moderate amount of pressure,
a large amount of this thickened bursa was avulsed from the phar3Tigeal wall. The re-
maining pieces of bursal tissue were teased away from the pharyngeal wall by means of
a KeUy clamp, and the mucosa surrounding this mass was denuded. The patient was
returned to her room in good condition.

Pathology Report: This showed the bursa to be chronic inflammatory tissue.

Follow-up: The patient made an imeventful recovery. For about ten days she had a
sore throat, but this eventually improved. The post-nasal discharge never entirely dis-
appeared. An inspection of the pharynx three weeks after operation revealed a small
amoimt of discharge. However, clinically the patient was improved. The sore throat
disappeared and the post-nasal discharge was so mild that it no longer annoyed her. She
remained asymptomatic until December 20, 1947, when she developed a head cold. This
improved after one week, but she again developed a sore throat and a profuse post-nasal
discharge. The purulent material was removed with a swab, and the nasopharjTix in-
spected with a mirror. High in the nasopharynx in the midline a small slit-like protrusion
was seen; pus was oozing from it. Inspection of the nose revealed some injection of the
mucosa but no evidence of sinusitis. She was gi\en Prothricin nose drops and advised
to return daily to have her pharynx cleaned with an antiseptic. With this treatment she
improved somewhat. At present, three months after the operation, although she has
improved, she still has the jwst -nasal discharge, and her pharynx is somewhat tender. A
roentgenograph of the sinuses taken on January 6, 1948 was negative.

CONCLUSION

1. A case of Tornwald's bursitis was reviewed and found to be resistant to
treatment with both radiation and surgery. The probable explanation lies
in the fact that the cavity of the bursa extends back near the base of the oc-
ciput bone and is therefore inaccessible to surgery.

2. This cavity in the nasopharynx, when chronically infected, may act as
a focus of infection and produce both local and systematic complications.
In the case presented the pansinusitis was undoubtedly a result of this con-
dition.

3. Symptoms of nasopharyngeal abscesses or cysts depend on whether
the abscess is closed or open and whether or not it is infected. The prin-
cipal symptoms are headache, chronic pharyngitis, post-nasal discharge,
sinusitis, frequent colds and hoarseness.

4. The treatment is usually excision of the bursa or the opening of the

KYPER AND CROSS— PHARYNGEAL BURSITIS 39

abscess with a probe if the symptoms result from inflanmiatory closure of
the median recess of the adenoid. However, results may be doubtful in the
former condition if the bursal tract extends back to the base of the occiput,
as it sometimes does.

BIBLIOGRAPHY

1. DoRRANCE, G. M.: The So-called Bursa Pharyngea in Man: Its Origin, Relationship

with the Adjoining Nasopharyngeal Structures and Pathology, Arch. Otolaryng.
13: 187-224, (Feb.) 1931.

2. Lederer, F. L.: Diseases of the Ear, Nose and Throat, Philadelphia, F. A. Davis

Co., 1946, pp. 621-623.

3. Woodward, F. D.: Nasopharyngeal Abscesses and Cysts, Arch. Otolaryng. 26: 38-41,

(July) 1937.

4. Yankauer, S.: Nasopharyngeal Abscess: A Report of One Hundred and Fifty-five

Cases, Tr. Am. Acad. Ophth. 34: 364-375, 1929.

DEPARTMENT OF OBSTETRICS
Case Report

The patient, a 24 year old primigravida, was admitted to the hospital because of vaginal
bleeding. The duration of pregnancy was estimated to be twelve weeks. The prenatal
course had been normal until twenty-four hours prior to admission, when vague abdominal
pains began. These were followed in ten hours by some vaginal spotting; the patient
estimated the total blood loss to be no more than a teaspoonful. On admission, the blood
pressure, pulse and respirations were within normal limits. At her first prenatal visit,
the cervix had been found to be normal, and the gravid uterus had been in a good position.

What is the treatment in this case?

DISCUSSION

Mall reports that 30 per cent of all spontaneous abortions result from mal-
formation of the fetus. This has been confirmed by Murphy. These reports
have led many obstetricians to take a moderately fatalistic attitude as to the
prognosis of threatened abortions. They no longer advocate the prolonged,
complete bed rest that was in vogue several years ago. The value of wheat
germ oil has never been established, and its use has been abandoned. Ac-
cording to Delfs and Jones, the role of the thyroid is gaining momentum in
the armamentarium and appears to be the most important approach to this
problem. Recently Vaux, Smith and Smith have advocated the use of
diethylstilbestrol. Theoretically, they assume, it might provide an ideal
agent for preventing progesterone deficienc}'^ in pregnancy by enhancing the
utilization of chorionic gonada tropin for the production of progesterone.

TREATMENT

An examination with the vaginal speculum showed the cervix to be nor-
mal. A gentle bimanual examination revealed the cervix to be long and
uneffaced. The basal metabohc rate was —15, and the patient was placed
on thyroid, 1 grain three times daily. Diethylstilbestrol, 25 mgm. daily,
was given by mouth. Thereafter, the daily dosage was increased by 5
mgm. at weekly interv'^als until a maximum of 125 mgm. was reached. The
administration was discontinued at the end of the thirty-fifth week.

The patient was discharged from the hospital in two days. She delivered
a normal child at term.

ANNUAL REPORT OF THE DEPARTMENT OF OBSTETRICS, 1947

SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND
FOREWORD

This 1947 report of the Department of Obstetrics is presented in a new
form in an attempt to make it more comprehensive. The Department
must apologize because some of the information desired could not be ob-
tained. This lack results from the fact that the decision to change the form
was not made until the year was completed and the information tabulated
in the old form. It is expected that the 1948 report will be more complete.

In analysing the figures presented, several points appear worthy of com-
ment. Maternal and fetal mortality rates are naturally interesting to
everyone concerned with obstetrics and in this connection we find an overall
maternal mortahty of 0.079 per cent or, on the basis of live births 0.905 per
thousand. A striking difference is found in the two races, the rate in the
colored being practically twice that in the white. One of the main reasons
for this discrepancy is the lack of hospital beds for negro obstetric patients
in the city. Many of these women try to register for prenatal and delivery
care in the various local clinics, but cannot find accommodations anywhere.
As a result they go through pregnancy and labor unsupervised, and are only
admitted because of pathologic conditions. Of equal interest is the com-
parison of rates in the registered and non-registered patients.

A total fetal mortality of 33.66 per 1000 births gives us no cause for self
congratulation but does demonstrate the point toward which effort should be
directed more and more in the future. The greatest good would be accom-
plished by the reduction of the number of premature births. For example,
in this report of a total of 127 live premature births, 27 failed to survive the
neonatal period, a mortality of more than 21 per cent, while among 3199
term Uving babies, only 19 succumbed, 0.59 per cent.

A cesarean section rate of 2.92 per cent would seem to compare favorably
with that of many clinics, and while it does not appear as a separate fact in
the report, the maternal mortality following this operation was zero. There
were 21 extraperitoneal sections done; in the majority this type of section
was done in order to gain experience with the operation, rather than because
of frank or potential infection. Tentative conclusions from this small
series are that the operation is comparatively simple and in a limited number
of cases is safer than the transperitoneal approach. However, in the prop-
erly supervised patient, the necessity for it should not arise.

One therapeutic abortion was done in the course of the year. The preg-
nancy in this case was within two weeks of viabiHty and the indication was
severe preeclampsia which did not respond to treatment.

42 BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

A total of 300 cases of toxemia of all kinds was seen and 2 of the 3 maternal
deaths were in this group of patients.

An attempt has been made to give the causes of fetal mortality in the
greatest possible detail.

My sincere thanks go to all those associated with the department in every
way. To their unswerving devotion to duty, to their efforts, often at con-
siderable personal sacrifice and to their skill and interest go the credit for
the results shown below.

Louis H. Douglass, M.D.

Summary
1947

TOTAL

HOME

HOSPITAL

White

Colored

White

Colored

1. Number of patients discharged. . . .

2. Number of patients delivered and

discharged (twins 36 sets)

a. Patients delivered of viable
infants

3755

3423

3350

3
0.905

3386

3227

159

3316

3189

127

70
38
32
20.06

46
19

27
13.87

114
33.66

10
10

824

805
19

809

779

795

771

6
17.3

3
2
1

3.77

16
19.7

1726

1551

1513

1
0.66

1524
1472

1502

1458

22
14
8
14.4

22
10
12
14.64

46
30.1

1195

1038
1022

b. Patients aborting

3. Maternal mortality

a. Rate per 1000 live births

4. Number of viable babies bom

a. Term

2
1.98

1043
966

b. Premature*

5. Number of living babies

1009

a. Term

950

b. Premature

6. Number of stillbirths

a. Term

b. Premature

c. Rate per 1000 viable births . . .

7. Number of neonatal deaths

a. Term

b. Premature

c. Rate per 1000 live births

8. Total fetal mortality

18
32.6

21
7

14
20.81

a. Rate per 1000 births ...*.....

49.8

' A premature baby is one which weighs less than 2500 grms. at birth

1947
Premature and Full Term (Delivery Dlagnosis)

PRESENTATION

SPON. DEL.
HOME

SPOK. DEL.
HOSP.

OPERATION
FROM BELOW

OPERATION
FROM .\B0VE

TOTAL

White

Colored

White

Col-
ored

White

Colored

White

Col-
ored

White

Colored

Vertex

Face

Brow

Breech

Transverse

Compound

Unknown

807
2

224

513
3

1195

424

37
2

1466

1791

51
9

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

1947
Types of Delivery

1. Spontaneous.

2. Operative. . .

a. Forceps — total

Indications

Control

Presentation occiput poste-
rior

Delivered as such

Following forceps rotation . . .
Following manual rotation . . .
Presentation occiput transverse .
Following forceps rotation . . .
Following manual rotation . . .

Presentation face

Labor prolonged

1693

1297

180

210

174

b. Breech extraction-total

Frank breech

a. Decomposed

Full breech

Primigravida
Multigravida
Head — af tercoming — forceps to

c. Version — Internal podalic and breech extraction-

total

Indications

Presentation transverse

Second twin

d. Craniotomy — total

Indications

Disproportion cephalopelvic

e. Other destructive operations — total
Indications and tjqaes

Laparotomy (other than cesarean section) — total. ,
Indications and type

Uterus: rupture of

Hysterectomy — supravaginal
Cesarean section — all types — total

251
1283

1231

621

1482

1904

43.76

56.23

1185

518

1703

1298

182

217

2
4

50.29

2.75

7
6

0.21

1
1

0.029

100

2.90

DEPARTMENT OF OBSTETRICS— ANNUAL REPORT

Types op Delivery — Continued

Indications

1. Pelvis contracted

2. Baby — excessive size of

3. Inertia uterine

4. Malpresentation

5. Pelvis — tumor blocking

6. Placenta previa

Centralis

Partialis

Marginalis

7. Placenta — premature

separation of

Complete

Partial

8. Preeclampsia

9. Posteclampsia

10. Eclampsia

11. Hypertensive disease

12. Section previous

a. Disproportion

b. Scar suspected

c. Toxemia

d. Rh negative

13. Presentation breech

14. Primigravida elderly

15. Vertebra cervical — dislocation

16. Tuberculosis — hips

17. Lymphogranuloma inguinale.

18. Presentation face

19. Fetus-habitual death of

20. Presentation transverse

21. Diabetes mellitus

22. Glomerulonephritis

23. Fibroids — multiple

24. Stricture rectal

25. Presentation — funis

TO-

t s

E w

TAI

< ^

^•^

a o

W "

►^

&<■

2
1

8
1

17
9

2
5
1

1
1

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

1947
Other Operations and Procedxjres Not Including Delivery

1. Episiotomy — total

a. Central

With rectal laceration

b. Paramedian

With rectal laceration

2. Perineorrhaph}- — total . .

a. Indicated (laceration)

b. Elective (old R.V.O.)

3. Tracehlorrhaphy — total

a. Indicated

b. Elective

4. Hysterostomatomy — total

a. Dystocia cervical : f orecoming head

b. Dystocia cervical: aftercoming head

5. Hysterectomy — total

a. Uterus couvaillaire

b. Uterus — rupture of

c. Uterus — fibroids of

d. For sterilization only

e. Von Willebrand's Disease

6. Dilatation and curettage — total

a. Secundines retained

b. Mole, hydatidiform

7. Placenta, manual removal of — total

a. Placenta adherent

b. Placenta retained

8. Plematoma, evacuation of

9. Fetal scalp clamp — application of — total . .
a. Placenta previa

b Placenta — premature separation of
c Inertia uterine

10 Amniorrhexis for induction of labor — total

a. Preeclampsia

b. Hypertensive disease

c. Placenta previa

White

Colored

1620

1549
72
71

235

156

136
92
44

13
13

_5
1
1
1
1
1

4
7

30
19

4
2

DEPARTMENT OF OBSTETRICS— ANNUAL REPORT

Other Operations and Procedures — Continued

10. Amniorrhexis for induction of labor — total, Cont.

d. Placenta — premature separation of

e. Rh negative with antibodies

f . Convenience

g. Labor— missed

11. Sterilization

a. Section previous

b. Multiparity (para 7 or more)

c. Hypertensive disease

d. Renal disease

e. Pathology cardiac ,

f . Accompanying section

g. Burns — body — 3° ,

h. Diabetes mellitus

i. Disc — intervertebral — recurrent herniation

. j. Deficiency — mental

k. Tuberculosis — pulmonary

1. Keratitis — interstitial

m. Epilepsy

12. Cystocele — repair of,

Abortions — total ,

Therapeutic — total

a. Hypertensive disease

b. Preeclampsia

Spontaneous — total

a. Syphilis — maternal

b. Hypothyroidism

c. Dysfunction — endocrine

d. Fetus — abnormality of

e. Etiology — undetermined

Requiring completion

Complications

Maternal

Placental — total

Placenta previa centralis

Placenta previa partialis

Placenta previa marginalis

Placenta, premature separation of

a. Implanted normally

b. Implanted low

White

Colored

TOTAL

2.1

^?>

Other Opeeations and PiOCEDfUEES — Continued

Maternal — Continued

Placenta retained

Placenta adherent

Placenta, anomalies of

Cord, prolapse of

Pelvis contraction of (roentgen-ray classification)
Gynecoid — small

Android

Anthropoid

Platj^elloid

Mixed types

Labor

Prolonged

Shock antepartum

intrapartum

postpartum

Uterus

inertia

rupture of

inversion of

Ring contraction

Membranes — rupture of — premature

Dystocia — cervical

Hemorrhage and blood dyscrasia

Anemia

Hemorrhage

antepartum

intrapartum

postpartum

Rh negative — total

with antibodies

Cardiovascular disease

Rheumatic

Congenital

Hypertensive

Toxemia

Kypertensive disease

Benign

Mild

Severe

Malignant

Renal disease

Nephrosclerosis

Glomerulonephritis

White

Colored

5
24

7
19

273

4
22

148

343

276

23
20

133

132

100

1
5

DEPARTMENT OF OBSTETRICS— ANNUAL REPORT

Other Operations and Procedttres — Continued

Maternal — Continued

Acute

Chronic

Nephrosis

Acute

Chronic
Renal disease — other forms

Preeclampsia

Mild

Severe

Eclampsia

Convulsive

Nonconvulsive

Vomiting of pregnancy

Unclassified
Infection

Genita 1 tract

Puerperal

Wound — perineal

Others

Respiratory

Pneumonia — all types

Tuberculosis active

Tuberculosis arrested

Urinary tract

Pyelitis — antepartum

Pyelitis — postpartum

Infection miscellaneous

Mastitis suppurative

Phlegmasia alba dolens

Hydramnios

Mole hydatidiform

Diabetes

Sclerosis multiple
Malignancy — generative tract

Epilepsy

Rectum — stricture of

Hemiplegia

Fetal

Injury and disease

Hemorrhage intracranial

Atelectasis

Newborn — hemolytic disease of

Fracture — cranial

White Colored

144

5
12

267

200

171

4
4
1

;q\ty of

'>-<

'ARY

i213

'C'Oz.

OF M£0

.CA^

50 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Other Operations and Procedures — Continued

Fetal — Continued

Infection

Diarrhea . . . .
Thrush
Impetigo . . . .
Other

Development — abnormalities of .

Hydrocephalus

Spina bifida

Other : Anencephalus

Minor

SERVICE

TOTAI,

White

Colored

28
12

7
9

26
3
2
1

Total Number of Viable Babies (Twins 36 sets)
Born alive

3386
3316

HOME DELIVERY

HOSPITAL DELIVERY

TOTAL

Wh.

Col.

Wh.

Col.

r»

L.
11

24
10

Birth weight

less than 1000 grms.*

1000 to 1499 grms

29
58
13

1500 to 1999

2000 to 2499

All premature live births

100

Term live births (2500 plus grms.)

779

2 1448

943

3180 19

* Lived for 48 hours

DEPARTMENT OF OBSTETRICS— ANNUAL REPORT

PKEMATUEE LABOR— CAUSES OF

Induced

Toxemia

Preeclampsia

Posteclampsia

Hypertensive disease

Renal disease

Other toxemias
Hemorrhage

Placenta previa

Placenta — premature separation of .

Other hemorrhages
Diabetes
Hyperth3Toidism
Hydramnios

Fetus — ^gross abnormality of
Fetus — ^habitual death of

Spontaneous

Toxemia

Eclampsia

Hypertensive disease

Renal disease

Other toxemias

Hemorrhage

Placenta previa

Placenta — ^premature separation of . .

Other hemorrhages
Membranes — premature rupture of ... .

Syphilis

Hydramnios

Pregnancy multiple

Surgery — abdominal

Disease — maternal — acute — infectious
Pathology — cervical

Fetus-abnormalities of

Fetus-intrauterine death of

Cause undetermined

HOME DELIVERY

HOSPITAL
DELIVERY

Wh.

Col.

Wh.

Col.

2
(1)

1
1

8
2

1
1

2
1

5
4
3

(1)

154
17

2
13

3
10

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

1947
Etiology of Neonatal Mortality (Stillbirths and Deaths in Live Born)

Hemorrhage intracranial

Disproportion cephalopelvic

Delivery vertex — traumatic

Delivery breech

Version — Internal podalic and extrac
tion
Anoxemia

Placenta — ^premature separation of

Placenta previa

Toxemia

Cord — umbilical compression of

Complications — medical

Undetermined

Development — anomalies of

Infections

Syphilis

Pneumonia

Septicemia

Diarrhea

Prematurity

Disease — hemolytic — congenital

Hemorrhage other than cerebral

Injuries

Miscellaneous

Undetermined

Total

PREUATUSE

Home
delivery

Wh. Col.

Hospital
delivery

Wh. Col

FULL TERM

Home
delivery

Hospital
delivery

Wh. Col

20
1

25
6
2

18
9
9

23
1

114

]\1aternal Morbidity — Not Obtainable for 1947
Maternal Mortality — 1947

ADULT DEATHS

Non-maternal mortality
Maternal mortality

Registered clinic patients

Non-registered clinic patients .

Private patients

WHITE

COLORED

TOTAL

0.079
0.047
0.653

DEPARTMENT OF OBSTETRICS— ANNUAL REPORT
Mortality Rate per 1000 Live Births

Registered clinic

Non-registered clinic

Private

Combined

TOTAL

HATE

WHITE

RATE

COL.

1
2

0.49

7.22

10.4

0.905

0.66

0.62

5.52

1.10

Maternal Mortality Covering Ten Year Period

Peritonitis and uremia

Pregnancy, abdominal

Abruptio placenta

Shock, intrapartum (without hem-
orrhage)

Embolus, pulmonary

Infection, puerperal

Uremia

Reaction, tranf usion

Anesthetic

Heart disease, rheumatic-decom-
pensation

Liver, acute yellow atrophy of

Cardiovascular collapse

Cardiac dilatation

Uterus, rupture of

Hemorrhage, intracranial

Arsphenamine encephalitis

Tuberculosis

Embolus, cerebral

Leukemia, acute myeloid

Eclampsia, ante and intrapartum . . .

Hemorrhage, postpartum

Ileus, paralytic

Adrenal gland, insufficiency of

Preeclampsia, severe, with shock . . .

Placenta previa

Bronchiolitis, acute

Total 64

Rate per 1000 Live Births

1938 1939 1940 1941 1942 1943 1944 1945 1946 1947

5.4

3.0

4.4

3.9

2.0

1.6

2.4

2.19

1.89

0.905

54 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Adult Mortalities

1947

30950 31 year old, colored, registered, para 0-0-0-0, admitted 7-6-47.

Diagnosis: Preeclampsia severe.

Intensive antitoxemia regime including digitilization. Under saddle block anesthesia,
routine central episiotomy, R.O.T. to R.O.A. with low forceps, delivered a full term, living,
female child, weight 4423 grms. at 4:45 P.M. 7-8-47, third stage normal. Total labor 44
hours, 45 minutes. Returned to room in good condition. B.P. 150/96. The patient
was found in shock at 4:56 A.M. 7-9-47, pronounced dead at 5:50 A.M., 7-9-47, ap-
proximately 14 hours postpartum.

Cause of death: Shock, postpartum, toxemic, secondary to preeclampsia, severe.
Autopsy: Refused.

34389 25 year old, colored, unregistered, para 1-0-0-0, admitted 11-25-^7, approxi-
mately 39 hours postpartum, in shock, temperature 103.6, having delivered
a full term, dead child, weight 3884 grms. at 9 A.M., 11-24-47. Tentative diagnosis on
admission was "acute septic endometritis with septicemia". Blood cultures positive for
E. coli. Intensive therapy with antibiotics, chemotherapy, blood, etc. No response to
therapy. Respirations ceased at 4:30 P.M., 11-27-47, approximately 71 hours postpartum
or 42 hours after admission to hospital.
Cause of death: Acute septic endometritis with septicemia.
Autopsy: Endometritis, postpartum septic; focal abscesses, kidney, bilateral.

34163— — 42 year old, white, unregistered, para 11-1-1-11, admitted 11-17-47, 26 weeks
gestation, not in labor, because of signs and symptoms suggestive of "acute
infectious hepatitis". Aborted spontaneously the day after admission, 11-18-47. Trans-
ferred to the Department of Medicine because of partial cardiac failure associated with
chronic hjTDertensive cardiovascular disease. Died at 11:55 A.M., 12-1-47.
Cause of death: Hj^ertensive cardiovascular disease, severe with cardiac decompensation.
AiUopsy: Glomerulonephritis, complicated by malignant nephrosclerosis, terminal; hyper-
tensive cardiovascular disease with cardiac hypertrophy; acute pulmonary
edema and congestion; anasarca.

PROCEEDINGS

of the
University of Maryland Biological Society

Officers of the Society

Rubert S. Anderson, President Donald E. Shay, Treasurer
School of Medicine School of Pharmacy

Baltimore, Maryland Baltimore, Maryland

Vernon E. Krahl, Secretary Ronald Bamford, Secretarial Rep.

School of Medicine Department of Botany

Baltimore, Maryland College Park, Maryland

Councilors

M. S. Aisenberg

F. H. J. Figge

W. E. Hahn

M. A. Andersch

The first program meeting for tlie fall term of the University of Maryland
Biological Society was held on Wednesday, October 29, 1947. The speaker
at this meeting was Dr. E. Rothlin, Professor of Pharmacology, University
of Basel, and Director of the Sandoz Chemical Works in Basel, Switzerland.
Dr. Rothlin presented a paper entitled: Old and New Aspects oj the Ergot
Alkaloids m Obstetrics and Gynecology.

Following the program, members of the Society cast their ballots in the
election of ofl&cers for the coming year. The names of the new officers ap-
pear above.

The following is an abstract of a paper presented at the regular monthly
meeting of the Society on November 19, 1947.

GENETIC RESEARCH ON THE Rh BLOOD TYPES AND THE RELATION OF
Rh INCOMPATIBILITY TO ABORTION*

Bently Glass, Ph.D.

The heredity of the Rh antigens, suspected from the first, was definitely confirmed in
1943 (Wiener and Landsteiner, 1943; Wiener and Sonn, 1943). With the discovery of
more and more Rh antigens, as well as the misnamed Hr reciprocal types, the nomencla-
ture had to be repeatedly revised and extended, imtil it became highly confusing. Into
this confusion the observation of the complementary nature of the Rh types and the sug-
gestion of the CDE/cde nomenclature (Race, 1944; Fisher and Race, 1946) brought a
considerable degree of light. General acceptance of this system has been impeded because
of the reluctance of many workers to commit themselves prematurely to a theory of

* Department of Biology, The Johns Hopkins University and the Baltimore Rh T3T3ing
Laboratory.

56 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

multiple, closely linked loci, as against one of multiple alleles. It should therefore be
pointed out that the system favored by Wiener actually does commit one to a particular
theory, as it is not adaptable to the possibility that three separate loci are present; whereas
the CDE symbols are readily adaptable either to a system of multiple alleles or to one of
multiple loci.

The test of these alternate theories can only be obtained, in such difficult genetic mate-
rial as the human species, by actually detecting crossovers between the three linked loci,
if such there be. The extensive data of the Baltimore Rh Laboratory should make this
possible. For example, in a family of type Ri x r, the commonest sort of test-cross family,
the genot5^es CDe/cde x cde/cde will yield only the parents' types in the absence of cross-
ing-over or mutation. But by crossing-over one could obtain in addition the types Cde/
cde and cDe/cde (R' and Ro) . By mutation still other types might arise, but these would
probably be much rarer. The possibility of illegitimacy must of course be kept in mind,
and such cases excluded by a consideration of a sufficient number of other hereditary
traits within the family.

Linkage between the Rh genes and other genes inherited in the same pair of chromo-
somes will produce association of the traits concerned within particular families, but not
in the population as a whole. The linkage of other traits with Rh is being looked for, as
being of great potential genetic and medical value. Other problems being studied in-
clude the causes for the low frequency of immimization of Rh-negative women (about
8 per cent of expectancy) ; the causes of the low frequency of erythroblastosis in births
to sensitized mothers (about 60 per cent of expectancy) ; the frequency of consanguinity
in marriages of Rh-negative persons; and the possible relation of Rh incompatibility to
other effects besides erythroblastosis, such as undifEerentiated feeble-mindedness, the
toxemias of pregnancy, and abortion and miscarriage.

A study on the last of these has just been completed. It shows that there is no sig-
nificant difference between the abortion rates (prior to the twenty-eighth week of preg-
nancy) in the three compared groups of Rh-positive, Rh-negative nonsensitized, and
Rh-negative sensitized women. A slight difference between the two latter groups in preg-
nancies after the fourth one may be entirely accounted for by the higher average number
of pregnancies in the latter group, inasmuch as the abortion rate goes up with increasing
number of pregnancies. An interesting finding was that for the Rh-positive group of 2500
women (5168 pregnancies), for all pregnancy groups from gravida-2's up, there is a higher
rate of abortion in the second half of the pregnancy history than in the first. This must
mean that biologic and/or psychologic factors tend to create a pattern of pregnancy num-
ber and family size in the individual woman, so that for each woman the abortion factor
begins to operate at a predetermined point, or increases in strength at a characteristic
rate.

At the meeting of the University of Maryland Biological Society held
on December 17, 1947, the following candidates were elected to member-
ship:

Dr. Joseph G. Bird

Mr. Edward B. Truitt, Jr.

The speaker at the December meeting was Dr. Dietrich C. Smith. The
following is an abstract of the paper presented.

UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY 57

SOME OBSERVATIONS ON THE PHYSIOLOGY OF THE FISH THYROID*
Dietrich C. Smith, Ph.D. and Samuel A. Matthews, Ph.D.

Three genera of Bermuda parrotfishes were examined and showed a discrete and con-
spicuous thyroid gland forming a mass ventral to the base of the tongue and extending
from the anterior end of the ventral aorta to the second afferent branchial artery. The
average dry weight of three glands gave a ratio of 29.4 mg./kgm. of body weight. Micro-
scopically the gland resembles that of other vertebrates. The follicles vary in shape 'and
size with the larger, more irregular ones near the center. They are lined with a simple
epitheKum whose cells vary in height from low cuboidal to columnar. With ordinary
staining methods the colloid appears homogeneous in some follicles and granular in others.
The surface of the gland is covered with a thin layer of connective tissue.

Eight small individuals Avere injected with three different dosages of I^^^ and killed from
six to twenty-four hours later. The thyroid, auricle, and a piece of the gill were removed,
dried, and applied to a roentgen-ray plate. After several days exposure the developed
plates revealed autographs of both the thyroid and the gill fragment, showing that the thy-
roid tissue had concentrated the I^'^. The control tissue, the auricle, had not concentrated
the I^^^ sufiSciently to affect the plate.

Extracts were prepared from the thyroid glands of these parrotfish and injected into
white grunts to determine their effect upon oxygen consumption. Oxygen consumption
of each fish was determined once a day by the open circuit method, using the Winkler
technique. Extracts were prepared from fresh glands, from glands dried whole, or from
glands powdered after drying. The drying was done either in an oven or with acetone.
Control injections were made with extracts prepared from brain, liver or muscle. The
results of the injections were as follows: Seven animals, averaging 15.5 grams in weight,
injected with control extracts, showed a 21 per cent increase in oxygen consumption; 10
animals, averaging 25 grams in weight, injected with th3rroid gland extracts, showed a 75
per cent increase in oxygen consumption; 12 animals, averaging 12.9 grams in weight, in-
jected with thyroid extract, showed a 9 per cent increase in oxygen consumption; and
5 animals, averaging 12 grams in weight, injected with dried thyroid powder, showed a 9.5
per cent increase in oxygen consumption. Positive responses were obtained only with
extracts prepared from fresh whole glands or from whole gland freshly dried in either
acetone or the oven, and were seen only in animals weighing from 15 to 32 grams. The
conclusion is drawn from these experiments that the oxygen consumption of white grunts
may be raised by injecting them with freshly prepared extracts of parrotfish thjToid gland,
providing the injected fish are not too small. All experiments were performed at the
Bermuda Biological Station.

The speaker at the January meeting of the Maryland Biological Society
was Dr. C. Jelleff Carr. The following is an abstract of the paper pre-
sented:

* Department of Physiology, School of Medicine, University of Maryland and Depart-
ment of Biology, Williams College, Williamstown, Mass.

58 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

A COMPARATIVE STUDY OF CYCLIC AND NONCYCLIC HYDROCARBONS
ON CARDIAC AUTOMATICITY*

C. Jelleff Carr, Ph.D. and John C. Krantz, Jr., Ph.D.

Meek, Hathaway and Orth (1937) showed that arrhythmias frequently occurred in the
dog's heart under cyclopropane anesthesia when the automatic tissue of the heart was
sensitized by intravenous injections of epinephrine. In this laboratory, it has been shown
that the Macacus rhesus monkey behaves in a similar manner and that cyclobutane anes-
thesia sensitizes the dog's heart to epinephrine in the same manner as cyclopropane anes-
thesia. In the present study the effects of other hydrocarbons related to cyclobutane and
cyclopropane have been investigated. Anesthesia in the dog under cyclobutane, cyclo-
butene, butane, isobutane and cis-trans 2-butene sensitizes the automatic tissue of the
myocardium to epinephrine. Anesthesia under ethylene does not elicit this response. Cy-
clobutane and cyclobutene produce an excellent anesthesia in the dog; butane, isobutane
and cis-trans 2-butene do not evoke satisfactory anesthesia in the dog.

At the program meeting of the Maryland Biological Society held on
Wednesday, February 18, 1948, Dr. Frank H. J. Figge presented some of
the results of his experiments in the coal mines of Pottsville, Pennsylvania.
Dr. Figge's paper was illustrated by a motion picture and colored lantern
slides. An abstract of the paper follows:

ATTEMPTS TO EVALUATE THE INFLUENCE OF PENETRATING

RADIATIONS ON CARCINOGENESIS. (MOVIES DEPICTING

COx\L MINE EXPERIMENTS)!

Frank H. J. Figge, Ph.D.

Since the discovery of cosmic radiation (Hess) , there has been much speculation on the
possible biologic effects of continuous exposure to this powerful penetrating radiation. To
test the possible influence of cosmic radiation on carcinogenesis, lead plates were placed
5-8 cm. above methylcholanthrene-injected mice to increase the frequency of showers of
cosmic radiation. The latent period for the induction of tumors was decreased in this
group as compared to the controls. Repetition of this experiment gave similar results.

The principle of cocarcinogenic action noted first by Shear and elaborated by Berenblum
and others will be invoked to reconcile the discrepancy between theoretical calculations,
which indicate that biologic effects should not occur, and the experimental results. The
results of experiments designed to test the hypothesis that the numerous, heterogenous
substances which we call carcinogenic agents are not, in themselves, carcinogenic, but
require activation by penetrating radiations, will be described. The low intensity-pene-
trating radiations are also non-carcinogenic in the absence of so-called carcinogenic chemi-
cals. According to this concept of cocarcinogenic action, cancer would be caused, not by
a single substance, but by two, three, or more interdependent non-carcinogenic agents.

This film shows the methods and m^aterials used to investigate the influence of cosmic
radiation on cancer. This includes the construction and dimensions of the lead-covered
cages, the mice, and some of the tumors produced in these experiments. An attempt was
also made to include more recent experiments to test the influence of lead plates and other
metals. Some of the experiments were designed to evaluate the relative carcinogenic
potency of gamma radiation and particulate radiation.

* Department of Pharmacology, School of Medicine, University of Maryland.
t Department of Gross Anatomy, School of Medicine, University of Maryland.

UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY 59

A program meeting of the Maryland Biological Society was held on March
17, 1948. Abstracts of the papers presented at this meeting follow:

AN EXPERIMENTAL STUDY OF GASTRIC EMPTYING IN THE
VAGOTOMIZED DOG*

Maurice Feldman, M.D.

AND

Samuel Morrison, M.D.

These experiments showed that prostigmin, mecholyl, acetylcholine and Doryl are para-
sympathomimetic drugs which stimulate gastric motility. It seems that acetylcholine
and Doryl are more effective than prostigmin and mecholyl in empt>'ing the stomach of the
bilaterally vagotomized dog.

Th3T:oid stimulates gastric emptying in the vagotomized dog. The effect of thyroid
is similar to that observed following the use of acetjdcholine and Doryl. Thyroxine did
not produce satisfactory gastric emptj'ing in the normal and vagotomized dogs following
paralysis produced by Etamon.

THE EFFECT OF INSULIN ON MOTILITY OF THE STOMACH FOLLOWING
BILATERAL VAGOTOMY

Maurice Feldman, M.D.

AND

Samuel Morrison, M.D.

Our experiments showed the following effects of insulin on the motility of the stomach :
(1) in the normal animal the administration of insulin accelerates the motility of the stom-
ach, (2) in the bilaterally vagotomized animal there is a greater inhibition of gastric
motility, exceeding that observed after bilateral vagotomy without insulin, (3) in addition
to the gastric motility inhibition, insulin further diminishes the gastric tone and causes an
increased gastric retention and greater dilatation of the stomach than that observed fol-
lowing vagotomy without insulin, (4) it would appear that the effects of insulin are mediated
through the vagus nerves. Finally, it is suggested that on the basis of the data presented,
a roentgen insulin test for the determination of vagotomy could be developed.

The Society did not meet in April.

The last program meeting of the 1947-48 series was held on May 19, 1948.
Doctor Frank H. J. Figge presented lantern slides, roentgenographs and a
colored motion picture illustrating some of his anatomic studies on the
Hypospray, a new instrument for subcutaneous and intramuscular injection.
The abstract of Doctor Figge's paper follows:

ANATOMICAL EVALUATION OF JET INJECTION INSTRUMENTSf

Frank H. J. Figge, Ph.D.

The film shows the L[ypospray (a new instrument, designed to minimize the pain and
inconvenience of hypodermic medication) being used to inject embalmed and unembalmed
cadavers and living subjects. These procedures were originally intended to evaluate the

* Department of Gastroenterology, School of Medicine, Universitj' of Mar34and.
t Department of Gross Anatomy, School of Medicine, University of Maryland.

60 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

anatomic potentialities of the instrument, but later involved also the adaptation of the
instrument to the skin of living human subjects.

A method was finally devised to permit the evaluation of the depth of penetration into
living subjects, and involved injecting a radiopaque substance, diodrast, which could then
be visualized roentgenographically.

On the basis of the investigations summarized by this film, it has been concluded that :

1. The HjT^ospray successfully injected aqueous solutions, colloidal suspensions, oil
solutions, emulsions, and even metallic mercury. It is evident that the Hypospray will
have few limitations with regard to the physical properties of the drugs that may be
injected.

2. The Hypospray may be used to give either intramuscular or subcutaneous injections.

3. The Hypospray technique will be far more convenient than the syringe and needle.
No part of the apparatus will require sterilization by the user.

4. The subtle influence that the introduction of this relatively painless method of
injection may have on the subconscious or psychologic attitude of the patient toward the
doctor cannot be evaluated at present, but may be more important and far-reaching than
any of the other advantages mentioned thus far.

ALUMNI ASSOCIATION SECTION

OFFICERS*

Albert E. Goldstein, M.D., President

Vice-Presidents

James S. Billingslea, M.D. E. Paul Knotts, M.D.! Chables C. Zimmerman

Thueston R. Adams, M.D., Secretary Simon Beager, M.D., Assistant Secretary

MiNETTE E. Scott, Executive Secretary Charles Reid Edwards, M.D., Treasurer

Board of Directors Hospital Council Library Committee

Wethehbee FoKT.M.D., Alfred T. Gundry, M.D. Milton S. Sacks, M.D.

^^"i""""" George F.Sargent, M.D. Representatives to General

Albert E. Goldstein, M.D. i^r ,■ ^ ■.. Alumni Bnar,i

„ T. xn n.^ T^ Normnattng Committee Aiumni Doara

Charles Reid Edwards, M.D. t . ,„ i., T^

Thurston R. Adams, M.D. Frank Geraghty, M.D . John A. Wagner, M.D

„ -r, -.T x^ Cliauman Thurston R. Adams, M.D.

Simon Bracer, M.D. „, „ „ ,t T^

Louis A. M. Krause, M.D. W. Raymond McKenzie, M.D. Willi.^m H. Teiplett. M.D.

Emil Novak, M.D. Frank Ogden, M.D. Editors

William H. Teiplett, M.D. Robert F. Healy, M.D. jq^j. a. Wagner, M.D.

Austin Wood, M.D. Ernest I. Cornbeooks, M.D. q Gardner Warner, M.D.

Alumni Council
Louis H. Douglass, M.D. Lewis P. Gundrv, M.D.

* The names listed above are officers for the term beginning July 1, 1948 and ending June 30, 1949.

NEWS ITEMS

Miss Ethel C. Rider of Owings Mills, Maryland, has made a generous
contribution to the Rare Book Restoration Fund of the Medical Library, in
memory of her father, Dr. William B. Rider. Dr. Rider was the youngest
member of the 1879 class of the School of Medicine, University of Maryland.
For over fifty years he practiced medicine in northwest Baltimore and was
well known and respected in the profession. His loss has been keenly felt
since his death, from coronary occlusion, in April 1947. The gift for the
restoration of the hbrary's rare medical books is a fitting tribute to Dr.
Rider's memor}^

On May 25, 1948 Rockland County, New York gave a testimonial dinner
in honor of Dr. Russell E. Blaisdell, who is retiring from the position of
Senior Director of the Rockland State Hospital on July 1, 1948.

Dr. Blaisdell attended the Baltimore Medical College and graduated in
1906. He interned at the Maryland General Hospital and has spent most of
his years of practice in state service at various hospitals in New York. He
was chnical director and first assistant at Kings Park State Hospital and
went to the Rockland State Hospital on July 1, 1930, when that institution
was first founded.

On May 26, 1948 the New England alumni of the Universit}^ of Maryland
School of Medicine held their annual luncheon at the University Club in
Boston. Twenty-eight members were present, and Dr. Charles W. Finnerty
(P. & S. 1913) of Somerville, Massachusetts presided.

OBITUARIES

Aycock, Thomas Bayson, Baltimore, Md; class of 1924; aged 52; died,

January 7, 1948, of cerebral hemorrhage.
Baughn, Edgar Buren, Colquitt, Ga.; P & S, class of 1904; aged 68; died

recently, of parkinsonism.
Carter, Benjamin L., Covington, Va.; B.M.C., class of 1893; aged 82;

died, December 7, 1947, of coronary thrombosis.
Crawford, Frank Herbert, Mount Sidney, Va.; P & S, class of 1896,

aged 74; died, January 14, 1948, of cerebral hemorrhage.
Devoe, Charles Payson, Pasadena, California; class of 1883; aged 87;

died, December 16, 1947.
Gallant, Benjamin Franklin, Northport, N. Y.; P & S, class of 1913;

aged 68; died, November 10, 1947, of coronary thrombosis.
Glasgow, Thomas M., Passaic, N. J.; B.M.C., class of 1902; aged 69;

died, November 29, 1947, of coronary thrombosis.
Glines, Walter Ashley, San Juan, P. R.; P & S, class of 1906; served

during World War I; aged 67; died, November 16, 1947, of arterio-
sclerosis.
Goodrich, Edward P., Winterport,-Me.; B.M.C., class of 1896; aged 73;

died, recently of cerebral thrombosis.
Hartley, Harold H., Terrace, Pa.; class of 1903; aged 70; died, January

7, 1948, of heart disease.
Monmonier, Joseph Carroll, Catonsville, Md.; class of 1897; aged 75;

served during World War I; died recently.
O'Neill, Joseph Berchman, Pawtucket, R. I.; class of 1900; aged 76;

died recently.
Rose, John Turner, Vineland, N. J.; B.M.C., class of 1894; aged 78;

died, December 17, 1947, of cerebral hemorrhage and arterioscle-
rosis.
Shirkey, D. W., Montgomery, W. Va.; P & S, class of 1891; aged 78;

died, November 19, 1947, of bronchopneumonia and hypertension.
Spengler, Nathaniel L., Tampa, Fla.; class of 1903; aged 69; died,

November 28, 1947, of myocardial failure.
Sprague, Seth Billingslea, Jersey City, N. J.; B.M.C., class of 1906;

aged 69; died, November 23, 1947, of pneumonia.
Warren, Edward Dane, Holyoke, Mass.; B.M.C., class of 1902; aged 70;

died, November 19, 1947, of cerebral hemorrhage.
Young, Clinton Michael, Kittanning, Pa.; B.M.C., class of 1906; aged

68; died, December 3, 1947.

BULLETIN

OF THE

SCHOOL of MEDICINE

UNIVERSITY OF MARYLAND

VOLUME 33 No. 3

Publishers:

Faculty of Physic

University of Maryland

Baltimore

PUBLISHED FIVE TIMES A YEAR
(JANUARY, APRIL, JULY, SEPTEMBER AND OCTOBER)

Lombard and Greene Streets
Baltimore 1, Md.

Entered as second-class matter June 16, 1916, at the Postoffice at Baltimore, Mar>iand
under the Act of August 24, 1912.

BULLETIN

OF THE

SCHOOL OF MEDICINE

UNIVERSITY OF MARYLAND

Vol. 33 OCTOBER, 1948 No. 3

PREVENTION OF THE TOXEMIAS OF PREGNANCY*!
JOHN E. SAVAGE, M.D.

BALTIMORE, MARYLAND

With the adoption of a classification of the toxemias of pregnancy by the
American Committee on Maternal Welfare (1937, and amplified in 1939),
uniform terminology in this field has become available. In this classification
preeclampsia and eclampsia are considered the only "true toxemias of
pregnancy", and are characterized by an acute hypertensive syndrome
usually arising during the latter third of pregnancy, usually accompanied by
varying degrees of edema and albuminuria, and sometimes by convulsions.
It is with the prevention of preeclampsia and eclampsia that this paper will
be concerned.

Since the toxemias of pregnancy, along with puerperal infection and
hemorrhage, constitute one of the three major causes of maternal mortality,
their prevention is vital. Some authors state that eclampsia and other
types of toxemia account for from 20 to 25 per cent of the maternal deaths
in the United States.

PRENATAL CARE

Perhaps the most important single measure in the prevention of toxemias
is intelligent prenatal care, for the institution of which American obstetrics
may be justly proud. The late Dr. P. Brooke Bland once said, "Prenatal
care is the watchdog of obstetrics". This is especially true of the prevention
of the toxemias.

Reports from a number of clinics show that good prenatal care can appreci-
ably lower the incidence and severity of eclampsia, but that the frequency of
preeclampsia is not greatly influenced thereby. Mortality reports from
these clinics also show that eclampsia is usually of the mild type if the patient

* From the Department of Obstetrics, School of Medicine, University of Maryland.
t Received for publication June 28, 1948.

64 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

has had prenatal care. However, the recognition and vigorous treatment of
the very early signs and symptoms of preeclampsia can do much to prevent
the appearance of more alarming states.

The success of prenatal care depends, in large measure, upon the establish-
ment of confidence between the physician and his patient. Thus the
patient's complete cooperation is more readily secured. A well-informed
patient will be more understanding of the experiences through which she is
passing and, therefore, will be more wiUing to abide by the restrictions
imposed. It is suggested that any physician practicing obstetrics insist that
each patient procure, read and frequently refer to one of the reliable standard
books on prenatal care written for the laity, in addition to the physician's
own specific printed instructions presented to each patient.

Routine prenatal care begins with the taking of a detailed history. A
careful and complete physical examination is then made. The following
laboratory and other examinations are ordered: Rh typing, blood typing,
blood serology, and blood count; urinalysis; chest roentgenography, and any
other tests or examinations which may seem indicated. Specific instructions
are given in the form of a booklet which should outline the "danger signals",
essential information concerning general hygiene, and specific data regarding
diet and any other factors the physician feels are essential. Prenatal visits
should be as frequent as circumstances require — the minimum being at least
once a month during the first six months, every three weeks during the sixth
and seventh months, twice during the eighth month, and weekly during the
last month. The frequency of these visits must be greatly increased if any
of the early signs or symptoms of toxemia appear.

In taking the prenatal history, certain considerations will aid in the detec-
tion of factors predisposing to the toxemias and call attention to the fact that
such a patient must be kept under strict observation. Special notice should
be given to the age and parity of the patient, because severe toxemia is more
frequent in the very young primigravidae. A family history of hypertension
is important, because it has been suggested that a familial tendency to this
condition may become evident in patients who develop residual hypertension
after preeclampsia. The patient's past history, as concerns conditions pre-
disposing to cardiovascular and renal disease and to the toxemias, is im-
portant because such patients must be kept under even more careful surveil-
lance, and must be given a special set of instructions. Under this heading,
the following may be outlined: the history of definite chronic vascular or
renal disease, previous pregnancy toxemia, diabetes, chorea, rheumatic fever,
scarlet fever, pyelitis-pyelonephritis and obesity.

PRENATAL DIET

A number of authors believe that optimal nutrition during pregnancy is a
potent prophylactic factor against the development of toxemia. Therefore,

SAVAGE— PREVENTION OF TOXEMIAS OF PREGNANCY 65

emphasis must be placed upon an adequate diet during pregnancy. Such a
diet should be high in protein, low in sodium chloride and fat, and well
balanced. The caloric content should be varied to suit the needs of the
individual patient (a limit of 2,000 calories per day is suggested). A specific
diet list showing the minimum daily essentials should be given to each
patient. This diet should be supplemented with calcium and multiple
vitamin preparations. Some authors stress high protein intake (at least 85
grams of animal protein per day) as a preventive of toxemia. It is also im-
portant that fat be limited, since it has been shown to aggravate any hepatic
injury present, and to interfere with the proper metabolism of protein. The
incidence of toxemia is increased in women who are chronically malnourished
and protein is one of the principal deficiencies in such groups. The daily
diet should include milk, eggs and lean meat, together with abundant fruits
and vegetables.

WEIGHT GAIN, BLOOD PRESSURE, AND EDEMA

Particular attention should be paid at each prenatal visit to weight gain,
blood pressure, the appearance of edema, and urinalysis for the detection of
albumin. It is beheved that the total weight gain throughout pregnancy
should be from 16 to 20 pounds for the normal person, perhaps slightly more
if the patient is under her normal weight at the onset of pregnancy, and
certainly less if the patient is overweight. It would be ideal to limit the
weight gain to 2 pounds per month in the normal patient. The usual and
pre-pregnant weights should be recorded on the prenatal record.

The upper limits of normal blood pressure are considered to be 130 mm.
mercury systohc and 80 mm. mercury diastolic, taking the patient's age and
pre-pregnant blood pressure (if known) into consideration. Any significant
elevation above these levels is considered early evidence of incipient toxemia
even in the absence of edema and albuminuria. It has been said that a rise
of 5 mm. in the diastolic pressure for each 10 man. rise in systolic pressure is
suggestive of the development of severe toxemia; and that the more sudden
the rise in blood pressure, the more serious is the implication.

Edema, one of the earliest signs of impending toxemia, may be prevented
in many instances by a high protein intake and the limiting of sodium
chloride to that naturally occurring in foods. In this connection it is im-
portant that patients be warned routinely against taking baking soda and
other sodium-containing substances for the rehef of heartburn or other forms
of indigestion. It is also helpful to give patients food lists showing the high-
salt foods to be avoided. In order to secure full cooperation on the part of
the patient, it is well to prescribe one of the available sodium-free salt sub-
stitutes. Constant repetition of these restrictions and the reasons therefor
seem to be necessary with many patients.

66 BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

Now and then a patient's urine may show a trace of albumin in the absence

of any other toxic sign. Such a finding must be regarded with suspicion and
more frequent observation instituted until the urine is negative, since the
appearance of albuminuria may be the first sign of developing toxemia.

EARLY SIGNS OF TOXEMIA

The recognition of the early signs of toxemia, such as abnormal weight
gain, elevation of blood pressure, the appearance of edema, and albuminuria,
occurring singly or in combination, and the immediate application of therapy
will accomplish much in the prevention of more serious toxemic states.
When any or all of these signs appear, the patient must be carefully in-
structed, without producing apprehension, that her welfare and that of her
baby depend upon her complete cooperation. As an aid to accomplish this,
a special set of specific instructions is provided which contains directions for
procuring more rest, maintaining strict dietary restrictions, and the keeping
of a fluid intake and output chart. Saline purgatives, ammonium chloride,
and mild sedatives may be prescribed if desired.

Sudden abnormal weight gain is usually evidence of edema whether
obvious or occult. Edema is caused by water retention and this, in turn, is
thought to result primarily from the retention of sodium in the tissues.
Therefore, successful treatment of edema depends upon sodium elimination.
This may be accomplished in most early instances by the use of small doses
of magnesium sulphate, ammonium chloride in enteric coated tablets, and
low salt diet. Authorities differ as to the value of the limitation of fluids to
the previous day's output, but in no instance should there be less than 20
ounces of fluid intake per day. If the weight gain is gradual but excessive,
it probably represents an increase in adipose tissue (resulting from over-
eating) rather than edema. In such instances, patients may be placed on a
1200 to 1500 calorie diet (for from seven to ten days) high in protein and as
salt-free as possible, with added vitamins. These patients are instructed
that they must lose weight before the next visit. Some authors have ad-
vocated the use of thyroid extract as an aid in controlling this type of weight
gain.

Any patient whose systolic blood pressure has risen to 130 or more at two
visits should be considered potentially toxic and carefully observed. An
increase in systolic pressure of 30 or more points, even if the total pressure is
less than 140, is considered pathologic. In many patients, following the
successful treatment of edema, there is also a fall in arterial pressure.

If albuminuria is found, the patient is seen again in two days. If albumin
is still present, the patient is instructed to collect a twenty-four hour speci-
men, to measure it, and to bring 4 ounces to the office. If the total albumin
excreted is five grams or more in twenty-four hours, the patient is hos-
pitalized.

SAVAGE— PREVENTION OF TOXEMIAS OP PREGNANCY 67

If the patient does not promptly respond to the above measures, she
should be hospitalized for more vigorous therapy, the details of which are
beyond the scope of this paper.

RECURRENT TOXEMIA

Since toxemias of pregnancy often recur in subsequent pregnancies, such a
problem should be anticipated when patients give a history of previous
toxemia. Such patients should be kept under the strictest observation
possible. When this history is obtained, it is well to secure a copy of the
previous medical records for full information concerning the duration of
pregnancy at the onset of the toxemia, the severity of the s}nnptoms, the
height of the blood pressure, and the result to the mother and baby. In the
majority of cases of recurrent toxemia, the hypertension exists between
pregnancies. Some authors feel that no woman should be exposed to
further risk if she has had two or more pregnancies complicated by toxemia.
Patients with previous toxemia history should be given special instruction
with reference to diet, rest and exercise, and should be seen more frequently
than the normal patient in order to control weight gain and to observe the
onset of any of the early unfavorable signs or symptoms. It is important to
evaluate the vascular status (ocular fundi examination is especially valuable
in this connection), including the cardiac reserve, and the renal function of
these patients. Some authorities believe in the administration of vitamin E
as a prophylactic measure in patients with the history of previous pregnancy
toxemia. Others advocate diethylstilbesterol for the same purpose. These
methods of treatment are not generally accepted at present.

SEQUELAE

In regard to the prevention of the sequelae of the "true toxemias of
pregnancy" — notably hypertension — it may be suggested that pregnancy
should be avoided in those patients who have definite signs of cardiovascular
disease, renal disease, and diabetes which has been difficult to control, since
these conditions are prone to increase the morbidity of the vascular system
during pregnancy. Although some believe that chronic nephritis is a result
of the toxemias, most writers consider hypertension as the only sequela.
Although reports from various sources vary as to the incidence of permanent
hypertension following preeclampsia and eclampsia, a fair average of these
statistics would be in the order of 40 per cent with a slightly higher per-
centage in cases of eclampsia.

Most authors agree that once toxemia develops, the older the patient, the
greater her parity, the higher the blood pressure during the pregnancy, and
the longer the toxemic state exists, the greater will be the incidence and
severity of the sequelae.

Vascular morbidity may be lessened and even prevented in a number of

68 BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

cases by the early recognition and proper treatment of the early acute
syndrome. If the measures outlined above are not successful, prompt
hospitalization is imperative. If intensive hospital [therapy is unsuccessful,
termination of pregnancy must be considered.

SUMMARY

1. Intelligent prenatal care is the most important single factor in the pre-
vention and amelioration of the "true toxemias of pregnancy" (preeclampsia
and eclampsia).

2. It is believed that an adequate protein intake in the diet together with
restricted sodium and fat intake may be an important factor in preventing
toxemia.

3. It is urged that weight gain during pregnancy be limited, and specific
measures in this regard are outlined.

4. Factors in the treatment of very early toxemic signs and symptoms
are presented.

5. A brief resume of the prevention of recurrent toxemia and the sequelae
of the toxemias is included.

BIBLIOGRAPHY

1. Adair, F. L.: Maternal Care Complications, Ed. 2, Chicago, University of Chicago

Press, 1941.

2. Bernstine, J. B., AND Price, L. N.: Analytic Survey of Eclampsia, Am. J. Obst. &

Gynec. 53: 972 (June) 1947.

3. Burke, B. S., and Stuart, H. C: Nutritional Requirements During Pregnancy and

Lactation, J. A.M. A. 137: 119 (May 8) 1948.

4. Committee, People's League of Health: Nutrition of Expectant and Nursing Mothers

in Relation to Maternal and Infant Mortality and Morbidity, J. Obst. & Gynaec.
Brit. Emp. 53: 498 (Dec.) 1946.

5. De Lee, J. B., and Greenhill, J. P.: Principles and Practice of Obstetrics, Ed. 9,

Philadelphia, W. B. Saunders Co., 1947.

6. Dexter, L., and Weiss, S.: Preeclamptic and Eclamptic Toxemia of Pregnancy,

Boston, Little, Brown and Co., 1941.

7. DiECKMANN, W. J. : The Prevention and Treatment of Eclampsia, Am. J. Surg. 48:

101 (April) 1940.

8. DiECKMANN, W. J. : The Toxemias of Pregnancy, St. Louis, C. V. Mosby Co., 1941.

9. Eastman, N. J.: Expectant Motherhood, Ed. 2, Boston, Little, Brown and Co., 1947.

10. Kellogg, F. S.: Treatment of Toxemia of Pregnancy, Med. Clin. North America 31:

1192 (Sept.) 1947.

11. LouGHRAN, C. H.: Weight Control, Diet and Fluid Balance in Pregnancy, Am. J.

Obst. & Gynec. 52: 42, 1946.

12. Luikart, R.: High Protein, Low Caloric Diet for the Prevention of Toxemia of

Pregnancy, Am. J. Obst. & Gynec. 52: 428, 1946.

13. Lull, C. B. (Ed.): Management in Obstetric Complications, Philadelphia, J. B.

Lippincott Co., 1945.

14. Macarthur, J. L.: Plasma Proteins in Pregnancy, Am. J. Obst. & Gynec. 65: 382

(Mar.) 1948.

SAVAGE— PREVENTION OF TOXEMIAS OF PREGNANCY 69

15. Standee, H, J.: Textbook of Obstetrics, Ed. 9, New York, D. Appleton-Century Co.,

1945.

16. Titus, Paul: The Management of Obstetric Difficulties, Ed. 3, St. Louis, C. V. Mosby

Co., 1945.

17. Vedder, J. B.: Prophylaxis and Therapy of Eclampsia, Wisconsin Medical Journal

37: 394 (May) 1938.

18. Whit ACRE, F. E., Loeb, W. M., Jr., and Chin, H.: Study of Eclampsia: Consider-

ation of 200 Cases, J.A.M.A. 133: 445 (Feb. 15) 1947.

REGIONAL ILEITIS* f

EDWIN O. DAUE, M.D.

BALTIMORE, MARYLAND

In 1932 Crohn and his associates integrated the clinical aspects, roentgeno-
graphic evidence, course, and surgical treatment of a disease process which
they termed "regional ileitis". Crohn (4) defines the disease as "a. chronic
non-specific, granulomatous inflammatory process occupying for the most
part the terminal ileum, and characterized by diarrhea, fever, obstructive
phenomena, and often by fistulous tracts". It is a disease which lends itself
favorably to surgical operation. Crohn himself makes no claim to the pri-
ority of a new disease; for, as Clark (1) states regarding regional ileitis,
"occasional references may be found in the literature since the early part of
the nineteenth century regarding a lesion of the ileum and cecum which
produced stricture, abscess, or fistula".

INCIDENCE

Statistical studies after fifteen years are now beginning to bear some fruit.
Original concepts have been modified but in the main are quite similar to
those established by Crohn. This is a disease of youth, showing its highest
incidence in the third and fourth decades, there being more cases in the third
decade than all the other decades combined. Three-fifths of the cases occur
in males. Early reports and impressions of its large incidence in the Hebrew
race have been disproven by larger series of cases gathered from increasingly
widely separated areas. Race and color seem to have no influence in its
occurrence. Eckel and Ogiivie (5) report 21 cases in which one-fiith were
negroes and none were Jewish.

ETIOLOGY AND PATHOLOGY

Despite extensive clinical and experimental research the cause of regional
enteritis remains unknown. The impression of many investigators gives a
consensus of some form of infection, the exact nature of which is unde-
termined. Dr. Crohn, in a personal communication to Dr. Walker of this
University, states that he believes a virus is the causative agent. The evi-
dence is circumstantial but bears the weight of the man who instigated the
present concept of this disease.

In contrast to the etiology, the pathology has been extensively and pro-
ductively explored. By definition and observation the disease involves the

* From the Department of Surgery, School of Medicine, University of Maryland,
t Read before Baltimore City Medical Society Nov. 7, 1947.

DAUE— REGIONAL ILEITIS 71

terminal ileum mainly but not to the exclusion of the remainder of the bowel.
The final 2 to 12 inches of the terminal ileum beginning at the ileo-cecal
valve and advancing proximally up the bowel constitute the majority of the
cases. However, reports of involvement include the entire ileum and jeju-
num, the entire small bowel including the duodenum, and various combina-
tions around to and including the sigmoid colon. A peculiar involvement
is the so-called "skip area" which consists of two or more inflammatory areas
separated by normal bowel. These are highly significant; for their lack of
detection at operation is a large factor in the percentage of recurrences.
The extent of the involvement is usually signified by enlarged lymph nodes
in the mesentery supporting the involved areas. These nodes are never
necrotic or calcified and are reliable guides in determining the boundaries
of the lesion. An association and relationship of regional ileitis to mesen-
teric lymph-adenitis as seen in children has been suggested by clinicians on
several occasions. To date no observation has been recorded of a transition
from acute lymphadenitis to chronic ileitis.

Histologically the lesion begins as a generalized inflammatory reaction
with increased vascularity, edema, and cellular infiltration. The cellular
reaction is that of the chronic or subacute type consisting of l3anphocytes,
plasma cells, and eosinophiles. The original cellular reaction is followed by
a fibroblastic one and invasion of the area by giant cells giving the appear-
ance of tubercles. These later lesions differ from tuberculosis in that they
never contain tubercle bacilli and they never caseate. Fibrosis continues,
and the once pliable erythematous injected organ becomes a firm, gray,
stiff tube with a lumen of variable diameter, always diminished and at times
all but completely obstructed. The fibrous reaction tends to be more pro-
lific when occurring in the large bowel, often forming large easily palpable
masses. In the small bowel there is ulceration of the mucosa as a result of
the constriction of the blood supply. The ulceration has a characteristic
site of occurrence, being located on the mesenteric side of the small bowel
with constriction of the bowel about a long irregular area of ulceration.

Fistulas are one of the outstanding characteristics of this disease. Crohn
in his early descriptions considered fistula formation as the fourth or terminal
stage; however, later evidence has shown that it may occur in any one of the
three stages — acute, subacute, and chronic. More recently Crohn (4)
declares fistulas "frequently precede by from one to fourteen years the onset
of active diarrhea and abdominal pain, thus constituting the one prodromal
symptom of regional ileitis". The mechanism of fistula formation has been
described by Ginzberg (8). Ulcers located on the mesenteric border per-
forate and form an abscess between the leaves of the mesentery. Contact
between the abscess wall and contiguous portions of small bowel, mobile
segments of colon, bladder, pelvic floor and scars of the abdominal wall with

72 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

subsequent adhesions and rupture of the abscess forms the fistula. A fre-
quent cause for persistent fistula following appendectomy with non-sup-
purative appendicitis is regional enteritis. Fistulas may be segregated into
the following categories: internal and external. The external type fall into
two categories: those occurring in previous operative scars on the anterior
abdominal wall and spontaneous perianal, rectal, and rectovaginal fistulas.
The latter type are the most common. Jackman and Smith (9) have made
these interesting observations concerning the anorectal manifestations in
114 cases of proved regional ileitis. Thirty-two per cent had an anal abscess
or fistula, 18 per cent had a mass palpable in the rectovesical or rectouterine
pouch and 8 per cent had an anal ulceration or a contracted anal outlet.
These figures emphasize the necessity of investigating for regional enteritis
young adults with any vague intestinal disturbance who have anal abscess
or fistula, or the history of abscess or fistula. Garlock (6) states that,
"these are due to crypt abscesses developing on the basis of the foul diarrhea,
rather than to direct fistulous communication between the diseased ileum
and the pelvic floor".

CLINICAL COURSE

The symptoms are but manifestations of the lesions already described as
having three phases or stages, with the outstanding exception of the develop-
ment of fistulas which may occur in any stage.

a. The acute or appendicular stage is attended by the classic signs of right
lower quadrant pain, nausea, vomiting, rebound tenderness and muscle
spasm.

b. The subacute or ulcerative stage is accompanied by diarrhea which is
mucoid in type, melena, anemia, general lassitude, debility and loss of weight,
all being signs of chronic nutritional deficiency as a result of poor absorption
and anorexia.

c. The chronic or obstructive stage characterized by the usual S3niiptoms
of incomplete small bowel obstruction — cramping pain, borborygmi, dis-
tention, anemia, palpable abdominal mass, and constipation.

The presence of anal pain, anal discharge or bleeding attended by ano-
rectal fistulas or masses may occur in any of the above stages. Intractable
abdominal fistula following celiotomy in the third and fourth decade is almost
diagnositic of regional enteritis.

DIAGNOSIS

Understandably but all too frequently the diagnosis of regional enteritis
is made at celiotomy for suspected appendicitis. Numerous case reports
attest this with 50 per cent and more of patients with regional enteritis
having had appendectomies in their recent past history.

The factors to be considered in the acute phase are abdominal pain, espe-
cially in the right lower quadrant, nausea, vomiting, fever, and possibly mild

DAUE— REGIONAL ILEITIS 73

diarrhea. These are the cases to be excluded from appendicitis and acute
pelvic injQammatory disease in the female. As the disease progresses the
presenting signs and symptoms are an abdominal mass, chronic mild diar-
rhea, moderate melena, anemia, loss of weight, excessive peristalsis, fistulous
tracts, and finally signs of increasing intestinal obstruction. The latter
group must be differentiated from malignancy of the bowel, chronic ulcera-
tive colitis, nutritional deficiencies such as sprue, and tuberculosis of the
small bowel. Roentgenographic examination of the small bowel is probably
the most important element in making a definite diagnosis. These roent-
genologic findings vary with the sites of involvement but the main changes
as stated by Kantor (10) still prevail, namely: "a filling defect proximal to
the cecum, abnormality in contour of the last filled loop of ileum, dilation of
the loops of ileum just proximal to the lesion, and the string sign — a thin
irregular line representing the constriction of the bowel lumen". These
findings being present and deficiency diseases having been ruled out there
remains only intestinal tuberculosis to be excluded. Primary intestinal
tuberculosis is a rarity in this country in our generation and the diagnostic
procedure done for pulmonary tuberculosis will exclude those cases of second-
ary intestinal involvement.

TREATMENT

Clark and Dixon (2) of the Mayo Clinic in a report on 44 cases and a
review of over 500 cases make the following statements: "There is no known
medical treatment of value but many observers have recorded spontaneous
cures. Those patients who have experienced progression of the disease
must certainly come to surgery for removal of the irreparably damaged
segments of intestine". This statement made in 1938 is just as true today
for the entire armamentarium of antibiotics has not had any prolonged effect
on either the progression of the disease nor the frequency of its remissions.
Non-absorbable sulfa compounds such as sulfathalidine and sulfasuxadine
and the antibiotic streptomycin are valuable adjuvants to the required in-
testinal surgery but remain essentially that.

The first consideration is that of finding the disease at celiotomy for sus-
pected appendicitis. An impressive total of postoperative fistulas attest the
inadvisability of removing the appexdix. A consensus from several sources
with wide experince shows that immediate closure with no intra-abdominal
procedures is the best course in cases of acute regional enteritis operated on
for appendicitis.

Except for the acute stage all the known cases of regional enteritis requir-
ing surgery present the following problems in management:

a. Should they be resected or short-circuited?

b. If resection is decided, should it be in one or two stages?

c. What treatment should be given the fistulas?

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Colp, Garlock, and Ginzberg (3) in a series of 40 cases without a death
advocate ileocolostomy with exclusion. Garlock and Crohn (7) have ex-
tended this series to 65 cases without a death. Their method requires tran-
section of the ileum well above the involved segment with inversion of the
distal loop of ileum and anastomosis of the proximal loop into the transverse
colon. They state that the inverted end of the ileum never "blows out",
nor does the excluded proximal colon become distended by back flow.
Actual proof that diversion of the fecal stream allows healing in the involved
gut is afforded by some cases which underwent resection as part of a two-
stage plan or because of recurrence at another site. Pathologic sections
showed subsidence of inflammation and healing of the ulceration. It was
also noted that the entero-abdominal wall, entero-enteric, and entero-vesical
fistulas healed spontaneously. The only recalcitrant fistulas were the ileo-
sigmoidal and these present a special major problem. In discussing this
plan of treatment Colp (3) states that the ileocolostomy with exclusion was
first done as the primary stage in a two-stage operation but the results were
so good that resection was not necessary. It should be mentioned that
ileocolostomy in continuity was tried but was abandoned as unsuccessful.
Garlock has referred to this as the "closed cesspool".

The best pubHshed results in the English literature are those of Crohn,
Garlock and their associates (7). Their figures are as follows:

Ileocolostomy with exclusion

One-stage resection

Two-stage resection

NO. PATIENTS

65
55
25

0 %
16.3%
12%

RECURRENCES

13.8%
19.5%
36.3%

Three reasons for not doing a two-stage resection are presented:

(1) The resected areas of ileitis after short-circuiting were in most in-
stances healed and the fistulas spontaneously closed.

(2) In spite of resection the recurrence rate was higher than in simple
short-circuiting.

(3) There was an appreciable mortality among the cases coming to resec-
tion.

Marshall (11) in his presentation of 48 cases with 22 cases resected and no
deaths and 4 cases with 1 (ileocolostomy only) is of the opinion that a two-
stage resection is preferable. His indications for resection of the terminal
ileum, cecum, and ascending colon are: in a small percentage of cases the
disease involved the cecum and ascending colon and in over half of the cases
the ileocecal junction is ulcerated. Marshall advocates a two-stage Miku-
licz procedure, resecting the terminal ileum, cecum, ascending and one-half
of the transverse colon with exteriorization and approximation of the tran-

DAUE— REGIONAL ILEITIS 75

sected colon and ileum. Six weeks after the original resection he does a
secondary closure and completes the ileo-transverse colostomy. Marshall
deems the resection necessary to remove the irreparably damaged bowel
which may give rise to further symptoms. In this respect he differs with
Colp (3) and his associates who believe the process regresses once the fecal
stream is diverted. The major difficulties with this procedure are primarily
a higher mortality and no decrease in recurrence rate. A secondary factor
is that of an open ileostomy draining onto the abdominal wall and all of the
egregious complications attending such a fistula.

Since 1936 there have been 19 proved cases of regional ileitis at the Uni-
versity Hospital. These cases were treated by five different surgical
methods, without mortality. Nine of these were treated by appendectomy,
4 had a primary resection, 4 had a two or more stage resection, 1 had an ileo-
transverse colostomy in continuity, and 1 simple celiotomy with closure.
It is of interest to note that since 1941 only 2 appendectomies have been
done and that all stage resections date from 1941. Two cases, later resected,
had had recent appendectomies followed by fecal fistulas. In 1946 there
were more admissions with regional enteritis than in any other year, 4 cases.
Of the 8 resections there have been 2 known recurrences and no mortality.

SUMMARY

Regional ileitis is a chronic non-specific granulomatous inflammatory
process usually involving the terminal ileum; characterized by fever, diar-
rhea, obstructive phenomena and often by fistulous tracts. Its highest inci-
dence is in the third and fourth decade, occurring slightly more frequently
in males and having no race specificity. The etiology is unknown but it
appears to be infectious rather than neoplastic. Pathologic progression
begins with acute inflammation followed by ulceration in the bowel lumen,
abscesses within the mesentery, fibrosis of the gut wall, constriction of the
bowel lumen and frequent occurrence of fistulas to contiguous organs, the
anterior abdominal wall and perineum. The terminal ileum is involved in
the greatest number of cases, but the disease may occur from the duodenum
to the sigmoid and skip areas frequently occur. Clinically the disease runs
a course roughly divided into three stages (1) the acute or appendicular,
(2) the subacute or ulcerative stage and (3) finally the chronic or obstructive
stage. Fistulas may be present in any of the three stages. Diagnosis in
the acute stage is frequently made at celiotomy for appendectomy; however,
fever, diarrhea, melena, anemia, loss of weight with or without an abdominal
mass and/or a fecal fistula in a young or middle aged adult should suggest
the possibility of regional ileitis. Roentgenologic findings are almost diag-
nostic in the subacute and chronic stages. Treatment should be supportive
and conservative in the acute stage. Chronic cases are best treated by ileo-

76 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

transverse colostomy with exclusion allowing the involved bowel fistulas to
heal spontaneously. Recurrence rates are still high despite ileo-transverse
colostomy with exclusion. It is suggested that the recurrence rate may be
decreased by the higher transection above the lesion in the ileum and more
diligent search for an excision of the skip areas. An appreciable decrease
in the recurrence should not be expected until the etiology is discovered.

CONCLUSION

Regional enteritis, a disease of some magnitude with perplexing ramifica-
tions, was first correlated into a definite entity by Crohn and his associates
in 1932.

An apparent increase in the disease is the result of the dissemination of
knowledge concerning its existence.

The diagnosis is frequently made at an operation for acute appendicitis.
Statistics show an appendectomy should not be done at this time.

Patients, especially those in the third and fourth decade, presenting anal
and perianal fistulas should be investigated for regional ileitis.

At present ileo-transverse colostomy with exclusion of the diseased bowel
offers the lowest mortality and the highest percentage of cures of those cases
presented for surgery.

Spontaneous cures occur not infrequently.

A brief report of 19 cases treated at the University of Maryland Hospital
has been presented.

DISCUSSION

Dr. J. E. Walker: Dr. Dane has given us a comprehensive picture of the
disease process, regional enteritis. The problem of treatment continues to
remain unsolved, and it is on this phase that I have a few points to make.

This is not entirely a disease to be treated by surgery. In a recent con-
versation I had with Dr. Crohn, he stated that almost 50 per cent of the pa-
tients he has seen do not have the disease severely enough to require surgery.
This is borne out in those cases in which a celiotomy is performed on a pre-
operative diagnosis of acute appendicitis, but instead an acute ileitis is found
and the abdomen closed without surgery for the ileitis. With medical ther-
apy many of these patients never return to surgery — a few have been followed
for ten and twelve years in other clinics. The therapy usually instituted
consists of bed rest, vitamins — especially B and D — high carbohydrate —
protein and low fat diet, courses of intestinal antiseptics and antispasmodics.
Every possible aid should be given to digestion for these patients. Dr.
Bockus has recommended the use of Pancreatin (4 gm.) after each meal, and
dilute hydrochloric acid (2-4 cc) if achlorhydria is present. It is not desir-
able to use the opiates for diarrhea unless it is unusually severe. Usually a

DAUE— REGIONAL ILEITIS 77

preparation of bismuth and kaolin with tincture of belladonna will take care
of the diarrhea.

The immediate results of ileocolostomy with exclusion as reported by the
Mt. Sinai Hospital Group of New York are certainly remarkable and have
not been equaled by reports elsewhere in the literature. However, in such
a procedure we must remember that the diseased bowel with its involved
mesentery is left within the abdomen. On the assumption that this is an in-
fectious process and certainly in the advanced cases with marked granulom-
atous changes in the bowel and with stenosis, obstruction and ulceration,
I believe that it is wrong to allow the diseased bowel to remain permanently
and thus act as a feeding source of infection for a future recurrence.

Ileocolostomy with exclusion is not a procedure that should be used in all
phases of the disease as the best and only method of surgical therapy. I
agree that in those cases in which obstruction and fistula are present, that
this operation should be the operation of choice at that time. After the
inflammatory process has subsided and the fistula healed, a second stage is
then in order with removal of the by-passed distal ileum and ascending
colon. By utilizing the staged procedure the patient has gained in strength,
and the resection is thus performed with far less risk. This method of ther-
apy is advocated by Bockus and his colleagues, and they believe that by
removing the diseased bowel and mesentery that the incidence recurrences
will be decreased. I want to reemphasize the point made by Dr. Daue —
that the transection of the ileum should be high above the disease process,
the 2-3 feet as advocated by Dr. Garlock even though a resection is to be
performed.

If the patient does not have the clinical evidence of obstruction, fistula or
abscess, should not one prepare the patient for a resection of the involved
area? Then if exploratory laparotomy reveals its practicability, the patient
is prepared and the diseased tissue may be removed — and why shouldn't one
then have a better chance of preventing a recurrence by removing the nidus
of infection. The advantages of a one-stage resection in the absence of
complications are a shorter hospitalization period with a boost in the morale
of the patient, only one chance of an operative fatality instead of two, and
less danger of extension of the disease process with adhesions and fistula
formation as result of handling the involved bowel at the first operation.

An analysis of the results from the Lahey Clinic a few years ago revealed
that they resected 22 patients without one fatality. Several procedures
were utilized — 5 had a primary resection, 4 had a preliminary ileocolostomy
and a later resection, and 13 had a Mikculicz type of resection. They had
4 patients with ileocolostomy only and 1 death among these. The Mikulicz
resection in their hands has proved to be a very safe procedure in many types
of intestinal surgery. This evening I have advocated the use of the staged

78 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

procedure because of complications and that a preliminary ileocolostomy
with exclusion does not require handling of the diseased bowel. Certainly
the Mikulicz resection will require extensive handling of diseased bowel to
mobilize it for resection at the first stage. Only a long period of follow-up
will tell us if this point is practicable and should be considered.

Shapirio has analyzed the results of sidetracking procedures on 88 patients.
The incidence of freedom of symptoms was only 30.6 per cent. This seems
unusually poor. Rhoads has collected 125 cases in which resection was per-
formed with an incidence of recurrence of only 9.2 per cent. Bockus tells us
that with the exception of the brilliant record of Garlock and Ginzberg, a
review of the literature indicates that the immediate mortality is not much
greater and that the chances of cure are two to three times as great.

BIBLIOGRAPHY

1. Clark, R. L.: Regional Enteritis, Symptomatology and Review of Cases, Proc. Staff

Meet., Mayo CUnic 13: 535 (Aug. 24) 1938.

2. Clark, R. L., Jr. and Dixon, C. F.: Regional Enteritis, Surgery 5: 277 (Feb.) 1939.

3. CoLP, R., Garlock, J., and Ginzberg, L.: Ileocolostomy with Exclusion for Non-

specific Ileitis, Am. J. Digest. Dis. 9: 64 (Feb.) 1942.

4. Crohn, B. B.: Regional Ileitis, Surg. Gynec. & Obst. 68: 314 (Feb.) 1939.

5. Eckel, J. H. and Ogilvie, J. B.: Regional Enteritis, Am. J.Surg. 53:345 (Aug.) 1941.

6. Garlock, J. H.: The Present Status of the Problem of Regional Ileitis., Am. J. Surg.

72: 875 (Dec.) 1946.

7. Garlock, J. H. and Crohn, B. B.: An Appraisal of the Results of Surgery in Treat-

ment of Regional Ileitis, J. A. M. A. 127: 205 (Jan. 27) 1945.

8. Ginzberg, L. : Persistant Abdominal Fecal Fistulas Due to Regional Ileitis, Surgery

7: 515 (April) 1940.

9. Jackman, R. J. and Smith, N. D.: Some Manifestations of Regional Ileitis Observed

Sigmoidoscopically, Surg., Gynec. & Obst. 76: 444 (April) 1943.

10. Kantor, J. L.: Regional (terminal) Ileitis: Its Roentgen Diagnosis, J. A. M. A. 103:

2020, 1934.

11. Marshall, S. F.: Regional Ileitis, New England J. Med. 222: 375 1940.

THE PRESENT STATUS OF STREPTOMYCIN IN THE
TREATMENT OF TUBERCULOSIS*!

HUGH G. WHITEHEAD, M.D., F.A.C.P.

BALTIMORE, MD.

Comprehensive reports on this subject have appeared in recent months and
are probably familiar to most readers. By comparison with these reports
the author's own clinical experience with the use of streptomycin in tuber-
culosis has been quite limited and can add little in the way of original obser-
vations. There might be some profit, however, in reviewing the important
work that has been carried out in this phase of tuberculosis research.

For several years prior to 1944, the effect of various antibiotics against
the tubercle bacillus had been studied intensively. In January, 1944,
Schatz, Bugie and Waksman (3) announced that a substance obtained from
certain strains of the actinomycete, which they called streptomycin, ex-
hibited a definite and consistent antibacterial activity in vitro against the
tubercle bacillus. At the Mayo Clinic, Hinshaw and Feldman (2) had long
been working on the chemotherapy of tuberculosis. They had demonstrated
the effectiveness of the sulfones in experimental tuberculosis and had estab-
lished a method of drug assay which proved valuable for testing the anti-
biotic substances. When these methods were applied to streptomycin, it
was at once apparent that the substance possessed tremendous therapeutic
potentialities in arresting guinea pig tuberculosis. Despite the unparalleled
difficulties of war time, commercial manufacture of streptomycin was begun
by Merck and Company, and clinical trial in various types of tuberculous
infection was begun. The results in 100 patients treated at the Mayo Clinic
were published in September, 1945 (2). Several months prior to June, 1946,
with funds provided by the Streptomycin Producers Association, the Com-
mittee on Chemotherapeutics and Other Agents of the National Research
Council launched (under McDermott (1) at Cornell) a small but important
study, directed primarily at the toxicity of streptomycin. At the same time
the Veterans Administration, Army and Navy began a joint investigation
into the effects of streptomycin upon human tuberculosis and by the spring
of 1947 over 400 cases had completed treatment. These cases were reviewed
in a three day conference at St. Louis in May, 1947. In November, 1946,
the American Trudeau Society began a clinical investigation on the use of

* From the Departments of Medicine, School of Medicine, University of Maryland and
the Johns Hopkins University.

t Presented at the Maryland Regional Meeting, American College of Physicians,
Baltimore, March 27, 1948.

80 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

the drug in pulmonary cases, and this study was closely correlated with the
studies being carried on by the Federal Agencies. The manufacturers of
streptomycin were able to produce a sufficient amount of the drug to permit
expansion of clinical research and donated a generous amount to the American
Trudeau Society. A group of eight qualified investigators in different parts
of the country were selected for these studies. A uniform protocol for the
cUnical, laboratory and roentgenographic study of the cases was agreed upon,
and a standard set up for the selection of cases which were to receive the
drug. In the pulmonary study the most important observation would, of
course, be the roentgenographic changes which occurred during the course
of treatment. To diminish the subjective element in roentgenographic inter-
pretation a "jury" of nine experts in pulmonary diseases was appointed,
none of whom had been directly concerned with the investigation. The
chest films of the treated cases were presented to this jury and the advice
of statisticians was used in keeping the records. A sincere attempt was
made to obtain completely unbiased judgments from the jury. The results
of the joint studies were pubhshed in two technical bulletins issued by the
Veterans Administration in August and September, 1947 (4, 5), and later
in the American Review of Tuberculosis. Increased production of the drug
soon made it available commercially to all. At first its cost was almost pro-
hibitive but gradually decreased, although it is still a factor to consider.
With the decrease in cost a decrease also occurred in the dose considered
effective until today most cases receive one gram a day at a cost of about
$2.00 a gram.

RESULTS

In studying a disease with the known variations pecuHar to tuberculosis
with the differences in virulence of strains, and differences in resistance in
individuals, evaluation of a single therapeutic agent is most precarious, even
when based on hundreds of cases followed for several years. The details of
controlled studies to date are available in the pubhshed reports, and they
indicate that streptomycin is a most important adjunct to accepted and es-
tabhshed methods of treatment of most types of tuberculosis. There is no
evidence that it can be substituted for rest and proper nutrition or for sur-
gery, and, for reasons that will be discussed later, it should probably not be
used in tuberculous infection with favorable prognosis, as e.g. in minimal
pulmonary disease.

The following conclusions have been reached in reviewing the cases studied
to date under proper control:

Prolonged study of over 500 cases of pulmonary tuberculosis of various types in the
moderately or far advanced stage show that:

WHITEHEAD— STREPTOMYCIN IN TUBERCULOSIS 81

Little or no change occurred in productive or fibrocaseous lesions during 120 days
of treatment with doses varying from 1 gm. to 3 gm. daily.

Some degree of clearing occurred in 90 per cent of unstable, exudative lesions which
had been unchanged or progressive for at least 60 days prior to streptomycin therapy.

It is not maintained that this clearing is often marked, or permanent. In
fact, extension of lesions occurred in 8 per cent of the cases toward the
end of treatment and in 16 per cent within four months of the completion of
treatment. The incidence of sputum conversion in the exudative case of
recent origin was of the order of 40 per cent.

The clinical improvement on streptomycin therapy was more impressive
than were the roentgenographic changes. Cough and the amount of sputum
were almost constantly reduced; fever, when it was present, was similarly
affected, and more than 80 per cent of the patients gained weight.

It is generally agreed that streptomycin should not be used in minimal
lesions, in uncomplicated primary tuberculous infection in children, and in
tuberculous pleurisy with effusion where there is no demonstrable paren-
chymal lesion. Seldom is the drug effective in tuberculous empyema.

In tuberculous meningitis and in miliary and other hematogenous dis-
semination the use of streptomycin is mandatory. These fatal types have
responded impressively when treated early and with adequate dosage.
Intrathecal use of streptomycin in meningitis is probably not necessary or
desirable.

With the exception of cutaneous sinuses and ulcerations of the mucous
membranes, which usually respond remarkably well to streptomycin, the
effect of the drug in other non-pulmonary types of the disease requires fur-
ther study. The oral route for the treatment of intestinal lesions likewise
needs further investigation.

As in pulmonary tuberculosis, there is often marked clinical improvement
when streptomycin is used in genito-urinary tuberculosis, bone and joint,
skin and ocular tuberculosis, with occasional striking objective improvement,
but the cases so treated are too few to conclude that lasting improvement
can be expected.

LIMITATIONS

If streptomycin were perfectly harmless, it could be given to every patient
with active tuberculosis regardless of the nature and extent of the tubercu-
lous disease. But streptomycin is not harmless. Its toxic effects have been
described in detail in published reports. Some of these toxic manifestations,
especially the damage to the eighth nerve, occur with alarming frequency
even with the lowest doses now considered effective, and the changes are
often irreversible. It is vitally important in giving the public information
on what has been observed in the treatment of tuberculosis with strepto-

82 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

mycin that neither the toxic effects nor the benefits to be expected be magni-
fied on the one hand or minimized on the other.

Another serious limitation in the use of streptomycin against the tubercle
bacillus in humans is the development of resistant strains. Drug resistance
probably occurs in some cases as early as the thirty-fifth day of treatment on
low dosage, and probably much quicker when large doses are used, as in
prophylaxis during surgical procedures. For this reason the use of the drug
in an attempt to minimize spread during or after major surgical procedures
is of questionable benefit. The cases so treated have sometimes shown a
spread despite the drug, and serious and fatal complications could not be
avoided because the disseminating bacteria had acquired a resistance to
streptomycin. As Dr. James Waring said at Atlantic City last June, "Don't
shoot at a dickeybird if shooting will leave you with an empty gun in the
face of a tiger!" (6).

The problem of relapse is another to consider. The period of observation
is still too short to be reasonably sure that the favorable results observed will
be lasting or that favorable effect from the drug can again be expected if
later progression of disease occurs.

PRESENT STATUS

There is little doubt that streptomycin is being widely used today in all
types of tuberculous infection. The commercial supply, for the time being
at least, is suflScient for current demands, and the price is reasonable. Im-
provement in the purity of the drug has probably lowered the incidence of
some toxic effects, but not those observed in damage to the eighth nerve. The
lowered dosage and the regimen of intermittent and interrupted dosage with
no apparent loss in favorable effect has made the use of the drug more desir-
able and practical. Studies are continuing on its use in combination with
the sulfones and with para-amino-sahcyHc acid with some promise. Other
antibiotics are being produced with the hope that one will be found with the
same or greater potentiaHties of streptomycin in tuberculosis but without
its toxic effects. There is no indication to date that the toxic properties of
streptomycin can be reduced or ehminated and still have it retain its thera-
peutic potentiaHties in tuberculosis. The question is often asked, "Can
streptomycin be used at home in the treatment of tuberculosis?" The an-
swer is that it can be and is being used extensively in office and dispensary
practice and administered at home. Whether this is sound practice may be
open to some question, as is the question whether the drug should some-
times, under certain circumstances, be self-administered. There is no doubt
that streptomycin, as with the sulfonamides and penicillin, is frequently used
where there is no clear indication, as judged by reliable experience to date.
It is also a fact that it is often used by therapeutic enthusiasts with
little special knowledge of tuberculosis and with no appreciation of what

WHITEHEAD— STREPTOMYCIN IN TUBERCULOSIS 83

harm might be done the patient, not to mention the financial sacrifice
often made to purchase the drug for use in cases with hopelessly destructive
disease.

Since streptomycin is not universally applicable in tuberculosis and since
it has formidable toxic potentiahties, it is of the greatest importance that
selection of cases for its use be made only by those physicians whose knowl-
edge of tuberculosis and streptomycin is sufiiciently broad to permit them to
choose wisely which patients should assume the discomforts, the risks, and
the expense of this new type of therapy. In making the decision to use
streptomycin in a case of tuberculosis, the hazards of toxicity and resistant
organisms must be compared to the hazards of the disease being treated.
The incidence of toxicity is probably higher and the development of re-
sistant organisms more frequent with streptomycin than with other useful
chemotherapeutic drugs.

AVAILABILITY OF DRUG TO INDIGENT

When the eflScacy of streptomycin in some types of tuberculosis became
estabUshed, the problem at once arose as to how funds for its purchase might
be provided for its use in indigent patients. In some states and cities im-
mediate grants were made by governmental agencies through their respective
health departments for use in institutions where other funds would not
suffice. In most instances a Streptomycin Committee was organized com-
posed of speciaUsts in tuberculosis in order that proper selection of cases
and most advantageous use of funds available would be insured. No
Federal funds have been made available for streptomycin except for or-
ganized research in certain designated institutions. It has never been the
policy of the National Tuberculosis Association to use money obtained from
seal sales for treatment of individuals, but in some states special appropria-
tions have been made by the local Tuberculosis Association for use in a
limited number of cases selected by competent authorities. In Maryland a
private organization known as the Streptomycin Gift Fund, Inc. has received
donations and supplied funds to certain cases. The author is not familiar
with the methods of this organization and has heard of no similar organiza-
tion elsewhere. Funds have been supplied occasionally by the Maryland
Tuberculosis Association for use in urgent cases such as tuberculous menin-
gitis, and contributions have been made to the National Tuberculosis Asso-
ciation for the research referred to above, which has been conducted by the
American Trudeau Society, the medical section of the N.T.A. It is the duty
of the City, County or State authorities to appropriate funds for strepto-
mycin for indigent persons in institutions with tuberculosis of such a char-
acter that streptomycin is clearly indicated. A Streptomycin Committee
has recently been appointed to work with the Maryland State Health De-
partment and make appropriate recommendations in this regard.

84 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

SUMMARY

A review of the investigations since 1944 of the use of streptomycin in
tuberculosis has been given and the results of these studies have been briefly
stated. The present status of the drug in regard to tuberculosis has been
outlined and the problems to be solved have been described. It now appears
that streptomycin alone is not adequate in those cases in which it should be
used, but is a valuable adjunct to bed-rest, proper diet and surgery, in cer-
tain selected cases. In some types of tuberculosis it is not useful and may be
harmful. The selection of cases for its use requires clinical judgment which
can be given only by those with long experience in the management of in-
dividuals with active tuberculous infection, and who are entirely familiar
with its toxic potentiaHties and the problems of streptomycin-resistant
organisms.

Note: The Bulletin feels it would be of interest to its readers to include the Report of
the Committee on Streptomycin with the foregoing article. This report was issued by the
State of Maryland Department of Health and is printed here with their permission.

Report of Committee on Streptomycin

In March, 1948, a Committee on Streptomycin was appointed by the
Director of the State of Maryland Health Department. The committee
was requested to recommend a program for the Health Department to fol-
low in the use of streptomycin for the treatment of patients with tuberculosis
in Maryland. Three specific questions were placed before the committee:

1) Should streptomycin be made available at this time to the patients in
the sanatoria operated by this Department?

2) Should funds be sought to supply free streptomycin to private physi-
cians for the treatment of their tuberculous patients?

3) Should streptomycin be added to the list of drugs, prescriptions for
which, written by physicians treating tuberculous patients under the
Medical Care Program, are to be filled at the cost of the state?

In conducting its inquiry, the committee as a whole and individual mem-
bers severally have:

1) Reviewed the current scientific Hterature regarding the use of strepto-
mycin for tuberculous infections.

2) Corresponded with Dr. Walsh McDermott, Associate Professor of
Medicine, New York Hospital, Cornell University Medical Center,
New York City, and with Dr. Arthur M. Walker, Secretary of the
Streptomycin Committee, Washington, D. C. (Veterans' Bureau).

3) Consulted with Dr. Carroll Pahner, U.S. Public Health Service, Wash-
ington, D. C, with Dr. Hugh G. Whitehead, chairman, Medical Ad-
visory Committee, Maryland Tuberculosis Association, with Dr.
Hugh J. Welch, vice-president, the Streptomycin Gift Bank Inc.,

WHITEHEAD— STREPTOMYCIN IN TUBERCULOSIS 85

and with Dr. Edward Kupka, Director of Tuberculosis Control,
California State Department of Health.

4) Reviewed 16 letters regarding the use of streptomycin written to Dr.
Hugh J. Welch by physicians in Maryland and in neighboring states.

5) Ascertained the present practices regarding the distribution of strep-
tomycin in several other states in the country.

Recommendations regarding the use of streptomycin for the treatment of
tuberculosis based on comprehensive study of the available evidence have
been made by the Committee on Therapy and the Subcommittee on Strep-
tomycin Therapy of the American Trudeau Society, (Am. Rev. Tbc, Nov.
1947.) A substantial body of evidence indicates that streptomycin is a
valuable drug m the treatment of certain types of tuberculosis. This drug,
however, is of no value or may be contraindicated for many types of the
disease which are frequent. Use of the drug must be restricted to relatively
short periods of time, approximately one to three months, and to limited
dosages, approximately one to two grams per day, because of the develop-
ment of drug-resistant strains of tubercle bacilli in the patient, and because
of the liability to the causation of serious toxic reactions, particularly
vestibular disturbances of a chronic nature.

The committee does not believe it would be desirable for it to make
specific reconmiendations regarding the indications and dosages of strepto-
mycin for the various types of tuberculosis. The report of the Committee
on Therapy of the American Trudeau Society provides an adequate summary
of the present status. The indications for the use of streptomycm may be
expected to change constantly as new knowledge is accumulated. In in-
dividual cases the decision regarding the use of streptomycin depends upon
the most careful and critical clinical judgment. Therefore, during the pres-
ent stage of rapidly advancing knowledge, streptomycin should be given
to tuberculous patients only under conditions where there is adequate op-
portunity for clinical follow-up and for qualified medical supervision of
control of the treatment.

At present, according to the limited survey conducted by the committee,
streptomycin is being made available for selected tuberculous patients in
sanatoria in several states such as, Massachusetts, Connecticut, New York,
Michigan, California and also in the District of Columbia. In each of these
areas safe-guards have been established to ensure the proper and effective
use of the drug. In none of these states is streptomycin being supplied free
to private physicians.

Recommendations:

In answer to the three specific questions placed before the committee, the
following unanimous recommendations are made:

1) Streptomycin should be made available at this time for selected pa-

86 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

tients in the sanatoria operated by the State Health Department.
The Director of the State Health Department should establish ap-
propriate safe-guards for the proper selection of patients to receive the
treatment and to ensure the effective use of the drug.

2) Funds should not be sought to supply streptomycin gratis to private
physicians for the treatment of their private tuberculous patients.

3) Streptomycin should not be added to the hst of drugs that are filled
at the cost of the state under the Maryland Medical Care program.

BIBLIOGRAPHY

(1). Farrington, R. E., Hull-Smixh, H., Btnsnsr, P. A., aito McDeiimott, W.: Strepto-
mycin Toxicity, Reactions to Highly Purified Drug on Long-continued Adminis-
tration to Human Subjects, J. A. M. A. 134: no. 5: 679, (June 21) 1947.

(2). Feldman, W. H., and Hinshaw, H. C: Proc. StaflE Meet., Mayo Clinic 20: 313,
(Sept. 5) 1945.

(3). ScHATz, A., BuGiE, E., and Waksman, S. a.: Streptomycin, Substance Exhibiting
Activity against Gram-positive and Gram-negative bacteria, Proc. Soc. Exper.
Biol. & Med. 65: 66, (Jan.) 1944.

(4). Veterans Administration Technical Bulletin 10-34, (Aug. 5) 1947.

(5). Veterans Administration Technical Bulletin 10-37, (Sept. 24) 1947.

(6). Waring, J. J.: Pulmonary Diseases, J. A. M. A. 136: No. 5: (Jan. 31) 1948.

FACE AND PERSISTENT BROW PRESENTATIONS*!
J. KING B. E. SEEGAR, Jr. M.D.

BALTIMORE, MARYLAND

This article is an efifort to analyze a series of face and persistent brow
presentations occurring at the University Hospital between January 1, 1935
and July 1, 1947. During this time there were 28,169 deliveries among
which there were 51 face and 16 persistent brow presentations. Of this
group there were 5 premature infants and 4 anencephalic monsters. All of
the latter were among the face presentations.

Thus the uncorrected incidence in the series was 1 face presentation in
552, and 1 persistent brow presentation in 1,760 deliveries. Excluding the
monsters and premature infants from these statistical studies, a corrected
incidence of 1 face presentation to 633 full term deliveries and 1 brow pre-
sentation to every 1,662 full term deliveries was obtained. It was interest-
ing to note that among the premature deliveries there was 1 face presentation
in every 313 or an incidence twice as great as among the term deliveries. It
was also found in this series (contrary to the findings reported in the litera-
ture) that the occurrence of these presentations was more frequent in
primigravidas than in multigravidas, 22 primigravidas and 20 multi-
gravidas were found to have face presentations, while 9 primigravidas and
7 multigravidas had brow presentations. Unfortunately there was no
available data as to the number of deliveries in these two groups in the clinic
during this time, though it is certain that the percentage of muciparous
deUveries was greater.

In contrast to these figures the older text books give the incidence as 1
face presentation in 200 deliveries and 1 brow presentation in 1500 or 2000
deliveries. Posner and Buch (10) in their series report 1 face presentation
in 529 deliveries and 1 brow presentation in 3,543 deliveries. Other papers
give the incidence of brow presentations as high as 1 to 1000 deliveries.

ETIOLOGY

The etiologic factors commonly listed for these conditions are:
1 — Contracted pelvis.
2 — Pelvic tumors.
3 — Placenta previa.

4 — Faulty axis of the uterus as in the pendulous abdomen of a multi-
parous woman.

* From the Department of Obstetrics, School of Medicine, University of Maryland.
t Received for publication April 30, 1948.

88 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

5 — Fetal monstrosities.

6 — Congenital spastic contractions of the fetal neck.

7 — Cystic tumors of the fetal neck.

8 — ^Large babies.

9 — Coils of cord around the neck.

10 — Hydramnios.

11 — Following external version.

In this series it was impossible in many instances to determine the etiologic
factors, though several outstanding causes seemed worthy of emphasis.
These were: 1 — cephalo-pelvic disproportion; 2 — large babies; 3 — ^monsters;
4 — multiparity and 5 — ^prematurity.

There were, among the face presentations, 7 cases of proved contracted
pelvis or an incidence of 16.66 per cent. All of these occurred among the
primigravidas which gives an incidence of contracted pelvis of 31.8 per cent
among them. Both of these percentages are high, particularly when con-
trasted with the incidence of cephalo-pelvic disproportion at the clinic for
the year 1935, which was 2.66 per cent of the total deliveries. No note,
however, could be found of contracted pelvis among persistent brow pre-
sentations.

Large babies may have accounted for 12 or 28.5 per cent of the face pre-
sentations and for 4 or 25 per cent of the brow presentations. The average
weight of babies with face presentations was 3374 grams and of brows was
3459 grams. Babies over 3629 grams were classified as large.

Multiparity may have played an etiologic role in 5 face and 3 brow pre-
sentations since these patients had had five or more pregnancies. However,
one must also remember that with multiparity there is a greater tendency for
large babies, which appears to have played a great part in this series. In
this group the babies with face presentations averaged 4338 grams while
those with brow presentations averaged only 3374 grams.

It is interesting to speculate as to what part prematurity might play in
face presentations, since in this study the occurrence was twice as frequent
among premature deliveries as among term deliveries. Posner and Buch
(10) reported that 12 per cent of their face and brow presentations were
among premature deliveries in contrast to the clinic incidence of 10 per cent
for prematurity. Here the explanation may be a small head with a rela-
tively large pelvis.

MECHANISM

In reviewing face and brow presentations a clear understanding of the
mechanism is essential. With face presentations the fetus assumes an
attitude of extension rather than flexion. The head is extended, with the
chin becoming the most dependent or presenting part, while the occiput

SEEGAR—FACE AND PERSISTENT BROW PRESENTATIONS 89

rests on the back. The neck is stretched, the chest thrust forward and the
breech thrust back. DeLee and Greenhill (2) aptly described the long axis
of the baby as forming an "S" curve. Descent and internal rotation occur
here as with a vertex lie, except that the head descends in extreme extension
instead of flexion and the chin rotates anteriorly beneath the pubis. The
head is then delivered by flexion rather than extension. It is also important
to realize that true engagement of the head does not occur until the bi-
parietal diameter enters the superior straight. In a normal vertex this
occurs when the presenting part is level with the ischial spines, while in a
face presentation the presenting part is well below this point. Two abnor-
mal mechanisms are deep transverse arrest, and persistent mentum-posterior.
It is generally accepted that delivery of a mentum posterior as such is im-
possible, since it is difl&cult for the relatively short neck to span the sacrum
and the head to deliver without the shoulders entering the pelvis at the same
time. Reed (11), however, cited 17 cases in the Hterature of normal-sized
babies that had been delivered in this manner. He showed by actual
mento-sternal measurements how this was possible, but it resulted in marked
distension and tearing of the perineum. Among the series of cases analyzed
at the University Hospital there was 1, a 26 year old, colored para 3-0-0-3
whose membranes ruptured twenty-four hours prior to labor. A diagnosis
of left mento-posterior was made when the cervix was 8 cms. dilated and the
head well engaged. At this time an unsuccessful effort was made vaginally
at manual rotation of the chin anteriorly. Six and one half hours later,
after a total labor of twelve hours, thirty-five minutes, the patient spon-
taneously delivered, as a left mento-posterior, a full term, living male child,
weighing 3118 grams.

The mechanism of a brow presentation is similar to that of an occiput
posterior. It is felt by most authorities to be a rather formidable presenta-
tion in large or even normal sized babies, since the longest diameter of the
head, the occipito-mental, engages in the pelvis. The brow rotates anteri-
orly with the chin behind the S5anphysis. The brow, bregma and occiput
then deliver over the perineum by flexion of the head followed by extension
of it with delivery of the nose, mouth and chin.

In this series 14.2 per cent of the face presentations terminated in spon-
taneous delivery while 18.7 per cent of persistent brow presentations
delivered spontaneously. The remaining cases all required active inter-
vention.

When discussing the mechanism of face presentations, most authorities
hold that prior to labor they exist as brow presentations, which are converted
to face presentations with the onset of labor. One would, however, be led
to believe that this conclusion was based only on speculation, since there
appear to be no studies along this line. Posner and Buch (10) state that

90 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

abdominal diagnosis is difficult and that in their series the largest proportion
of cases was diagnosed by rectal or vaginal examination in early labor with
ruptured membranes.

Among the author's series of cases it was difficult to determine the time
and method of diagnosis. However, it appeared from the case records, that
in the majority of instances the diagnosis was established only after labor
was well advanced. Thus it would seem that the old concept that prior to
labor face presentations usually exist as brow presentations may be the
result of a lack of early recognition.

DIAGNOSIS

The early diagnosis of these conditions is important, and one should
become well acquainted with the classic symptoms. The earliest signs
appear abdominally. Of these, as Posner and Buch (10) point out, the most
reliable is the unusually long ovoid configuration of the uterus. The
cephalic prominence is on the same side as the back in face presentations and
equally prominent in brow presentations. With face presentation there is a
deep sulcus between the cephalic prominence and back, while on the opposite
side the pelvis appears empty. The head is usually high in the pelvis. The
back is difficult to palpate and can frequently be felt only at the buttocks.
DeLee's triangle is absent and, as a result of the forward thrust of the chest,
the fetal heart is heard on the side where the small parts are felt.

On rectal or vaginal examination in face presentations the nose, orbits and
mouth may be felt through the dilated cervix. On pelvic examination the
fetus will at times suck on the examining finger. With brow presentations
these examinations reveal the anterior fontanelle at the center of the cervix
with the orbits felt near the periphery. In late labor rectal diagnosis is
difficult because of the marked molding and edema of the fetal head.

COURSE OF LABOR

The clinical course of labor in face and brow presentations is characterized
by prolongation, particularly of the first stage. This is the result of the
engagement of a large diameter of the head, necessitating marked molding
to permit passage through the pelvis. There is a further delay of internal
rotation which of necessity occurs at a much lower level in the pelvis, since
only here does the chin or brow meet sufficient soft tissue resistance. It is
also believed that because of the peculiar angulation of the fetal axis, the
force of uterine contractions is dissipated in the wrong direction. Many
authorities feel that with these presentations there is a tendency for pre-
mature rupture of the membranes which may predispose to longer labors.

In this series the average labor for the more formidable chin posterior
position was thirty three hours, twenty four minutes for primigravidas, and

SEEGAR—FACE AND PERSISTENT BROW PRESENTATIONS 91

twelve and one half hours for multigravidas. In the chin anterior and
transverse positions, however, the duration was fifteen hours twelve minutes,
and twelve and one-half hours respectively. According to Williams (14) the
average normal labor is eighteen hours for primigravidas and twelve hours
for multigravidas. Further analysis revealed premature rupture of the
membranes in 19 per cent of face presentations with an average labor of
twenty-nine hours. Thus for face presentations these studies substantiate
the occurrence of premature rupture of the membranes and prolonged labors
in primigravidas with posterior chin presentations.

The average labor for brow presentations was also prolonged, being 24
hours and 36 min. for primigravidas and twenty-three hours for multi-
gravidas. There was premature rupture of the membranes in 37.5 per cent
of the cases with an average labor, however, of only sixteen and one-half
hours.

PROGNOSIS

From a study of face presentations it is obvious that the prognosis of the
chin or mentum posterior variety is the more serious, especially for the baby.
In all face presentations one would anticipate an increase in the maternal
morbidity and mortality as a result of prolonged labors and an increased
incidence of operative interference. In this series only 14.3 per cent of the
face presentations delivered spontaneously. The maternal mortality how-
ever, was zero, although Reed, in an analysis of 75 cases of mentum posterior
presentations, found a maternal mortality of 11.6 per cent.

The prognosis of face presentations is far graver for the infant than for the
mother. There is a high incidence of intracranial hemorrhage from pro-
longed labor and cerebral compression. The neck is compressed against the
pubis, interfering with the return circulation to the head and causing pressure
on the trachea and larynx predisposing to fracture and suffocation. To
these mechanical difficulties must be added the increased risk of operative
deliveries. The total fetal mortality was 23.4 per cent for face presentations.
For the premature infants it was 60 per cent, and for the full term normal
infants 19.04 per cent. However, if the fetal mortality is computed sepa-
rately for mentum posterior and anterior presentations, it will be found that
2\ times as many babies died when the chin was posterior as when it was
anterior. Thus the fetal mortality was 29.4 per cent for mentum posteriors
as contrasted to 12 per cent for mentum anterior and transverse presenta-
tions. These results may be compared with those of Posner and Buch (10)
who reported a total fetal mortality of 19.6 per cent, while Williams (14)
quotes a rate of 14 per cent. Reed (11) found a fetal mortality of 40.6 per
cent for mentum posterior presentations and states that the usual fetal
mortality for mentum anterior and transverse presentations is 14 per cent.

92 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

The prognosis for persistent brow presentations is generally felt to be
more serious than that of face presentations for both the mother and infant.
In this series the maternal mortality was zero and the fetal mortality 18.7
per cent. However, one of the surviving infants suffered a severe intra-
cranial hemorrhage resulting in a spastic paraplegia. If this were included,
the fetal mortality and morbidity would be 25 per cent for the series. The
fetal mortality for brow presentations as found by Krehninger and Guggen-
berger (5) was 27.8 per cent, and by Posner and Buch (10) 20 per cent, while
DeLee and Greenhill (2) state that the mortality is 10 times as great as in
normal vertex deliveries.

TREATMENT

Unfortunately in the treatment of face and brow presentations no routine
method can be established. The course to be followed must be carefully
weighed in each case. In the mentum anterior and transverse presentations
most authorities advise a course of watchful waiting in early labor when
there is definitely no cephalo-pelvic disproportion. Since the fetal mortality
is high, as is also the incidence of cephalo-pelvic disproportion, especially in
primigravidas (31.8 per cent in the present series), the question of cesarean
section should probably be given careful consideration. Certainly cephalo
pelvimetry is indicated in the early labor of all face presentations, particu-
larly among first labors.

Where a course of watchful waiting is adopted, it is important to make
every effort to forestall the early rupture of the membranes. This is ac-
complished by doing gentle rectal examinations and by having the patient
lie on her side and not bear down. If the head is not completely extended,
the patient is placed on the side to which the occiput points, in the hope of
converting to an occiput; while if the head is fully extended, she will be
turned on the side to which the chin points to facilitate descent. A Schatz
maneuver, pushing on the breech and pulling on the shoulders, is advised
when the head is not engaged. This is done in an effort to convert to an
occiput. In the presence of no cephalo-pelvic disproportion, one should be
able to deliver a mentum anterior from below. If it becomes arrested in the
transverse position, the chin should be rotated anteriorly and delivered by
forceps. Posner and Buch (10) advise and describe a method of Kielland
forceps rotation in mentum transverse and obliquely anterior. They also
recommend no interference as long as there is progress and no disproportion.
The treatment of mentum posterior positions presents a much more serious
and diflacult problem. As a result of the fetal mortality, prolonged labor,
and maternal morbidity a number of authorities advise cesarean section in
early labor. The above named authors apparently feel that here abdominal
delivery is indicated, although others advise that a section should be done

SEEGAR—FACE AND PERSISTENT BROW PRESENTATIONS 93

only in the presence of cephalo-pelvic disproportion. This seems especially-
wise since these presentations may spontaneously rotate anteriorly in an
ample pelvis. If this does not occur, one still has recourse to conversion.
Thus when the cervix is two fingers dilated and the membranes ruptured, a
combination of the Zeigenspeck and Schatz maneuver may be employed.
Here two fingers are inserted through the cervix, making upward pressure
successively on the mentum, maxilla and brow while the external hand
presses down on the occiput.

An assistant performs the Schatz maneuver of pulling on the breech and
pushing on the chest. With further dUatation the Bandelocque maneuver
may be employed. This is a vaginal maneuver, pushing the chin and face
up and then pulling down on the occiput. The Thorn maneuver is a com-
bination of the Bandelocque and Schatz maneuver. DeLee (1) advised and
described a unique method of conversion used only with full dilatation of the
cervix and ruptured membranes. Here the head and shoulders are freed
from the pelvis, by the vaginal hand, and the chin and face pressed up, while
the external hand presses down on the occiput abdominally. The fingers
of the internal hand press back on the shoulders the thumb presses down on
the occiput. An assistant, in the meantime, pulls on the breech to maintain
flexion while the operator guides the flexed head down into the pelvis.
DeLee had excellent results with this technique in mentum posterior
positions.

A discussion of the treatment of mentum posterior would be incomplete
without the mention of internal podalic version and breech extraction which,
in the necessity of immediate delivery, is indicated, provided the membranes
have not been ruptured overly long and the lower uterine segment is not too
thin. Here, however, as a result of the extension of the baby, the uterus is
stretched, and the procedure is difficult. Posner and Buch (10) also point
out that, because of the molding of the head, the large occiput may wedge
against the promontory of the sacrum and prevent the after coming head
from dropping into the hollow of the sacrum. In addition to the increased
risk of this procedure to the baby, it carries also a high incidence of ruptured
uterus, a complication which cannot be too strongly emphasized. Because
of this, internal podalic version and breech extraction cannot be recom-
mended, and must be avoided whenever possible. When these methods of
conversion are impossible, one may still attempt to rotate the posterior chin
to an anterior position. Posner and Buch (10) here advise the use of
Kielland forceps. If the chin is in an obliquely posterior position, they
advise manual rotation to a transverse position and then the use of Kielland
forceps. These methods all having failed, one then has recourse only to
craniotomy.

In brow presentations the head frequently spontaneously converts into an

94 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

occiput or face presentation. Hence in early labor, when the pelvis is not
small or the baby large, a policy of watchful waiting should be adopted. It
may be helpful during this time to have the patient lie on the side to which
the occiput points, since this may assist in converting to an occiput and
preventing rupture of the membranes. An abdominal binder with a pad
over the occiput is also suggested. It is generally advised that if the brow
presentation persists after one or two hours of active labor, efforts at con-
version to an occiput and application of a Willett clamp, or conversion to a
face presentation should be made. DeLee and Greenhill (2) feel that the
presentation is a formidable one and that, if the head becomes deeply fixed
in this position, a cesarean section must be performed. They feel that if
labor is permitted to progress in the hope of a forceps delivery, the result
will probably be a craniotomy. However, since in a brow presentation,
descent usually does not occur until full dilatation of the cervix, others feel
that with the late first or early second stage of labor, the brow presentation
may still be flexed to an occiput or converted to a chin presentation. These
failing, internal podalic version has been advised. Among the present series
some were delivered as such by forceps in the late second stage while three
were delivered spontaneously as such. Krehninger and Guggenberger's (5)
series of 68 brow presentations, ZZ of which delivered spontaneously, make
one feel that the presentation is not as formidable as many might lead us to
believe. However, approximately 1 out of 4 of the babies died.

The following two charts indicate the method of treatment and end results
in the present series of face and brow presentations. It is interesting to note
that 23.8 per cent of the face presentations came to section, while none of the
brow presentations were so handled. Of the 1 fetal death following section,
it should be noted that this occurred in a patient with cephalo-pelvic dis-
proportion who was operated on after a labor of sixteen and one-half hours
at which time fetal distress was already present. From the chart on face
presentations the best results would appear to be in the cases converted to an
occiput. However, in reviewing the cases there were 11 notations of efforts
to convert to an occiput, of which only 4 were successful. In these 11 cases
there were 3 fetal deaths. It is felt that actually groups 2, 5 and 6 should be
classified together for a more accurate determination of the stillbirth rate
for face presentations delivered as such. Both craniotomies followed failure
to convert to an occiput. In both instances the fetus died following these
efforts and consequently craniotomy was elected rather than efforts to
rotate the chin anteriorly or perform internal podalic version. In one of
these cases the effort at conversion was made early in labor and the fetus
showed distress immediately thereafter.

With these additional facts in mind one might then deduce from the table
that the best results in face presentations were obtained first by cesarean
section and next by delivery as such with the chin anterior. The results

SEEGAR—FACE AND PERSISTENT BROW PRESENTATIONS

obtained through delivery by internal podalic version and breech extraction
were poor. One is also led to believe that the techniques outlined for con-
verting to an occiput are far more difficult to master in practice than in
theory.

It would be well to analyze particularly the mentum posterior positions
where the poorest results were obtained. Excellent results would have been
obtained by section had the 1 case been sectioned earlier rather than pro-
crastinating in the hope of delivery from below. In the other 12 cases

CHART I

METHOD OF

MENTUM ANT.

MENTUM POST.

MENTUM
TRANS.

TO-

STILLBORN OR

THEATWF.NT

TAL

OIED

Prim.

Mult.

Prim.

Mult.

Prim.

Mult.

No. of cases Full

term preg

Cesarean section..

5
Idled

1 or 10%

Delivered as such.

6
2 died

8
Idled

3 or 20%

Internal Podalic

Version &

Breech extrac-

tion

2 or 40%

2 died

Converted to oc-

ciput and for-

ceps

None

Converted to M.

A. and Forceps.

None

Spontaneous

Rotated ant.

and Forceps —

None

Craniotomy

1
1 died

1 died

2 or 100%

Total Stillbirths . .

8 or 19.04%o

terminated from below 4 infants, or 1 out of 3, died. Had all of these cases
been sectioned in early labor all of the babies could possibly have been saved.
Dealing still in percentages this would have increased the incidence of
cesarean section in the clinic by only 0.04 per cent. Hence it would appear
that section of all mentum posterior cases in early labor would greatly
decrease the incidence of stillbirths in the condition, while scarcely appreci-
ably increasing the incidence of cesarean section. The condition is appar-
ently not as frequent as formerly believed.

In viewing Chart II it is interesting to note that, among the brow presen-
tations, there were no sections. It is further interesting to note that at the

BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

time of delivery 5 cases were converted to an occiput or face presentation
and delivered by low forceps. Four were flexed and 1 was extended. One
would be led to believe that these may not have been true brow presen-
tations, but poorly flexed heads in 4 cases and more nearly a chin presen-
tation in the fifth case. If these were true brow presentations with their
associated molding, it would seem necessary for conversion to displace the
head upward in the pelvis, at least to the mid-forceps station. If this were
true, the incidence of brow presentation in this series would be 1 in 2560
deliveries which would give a face to brow presentation ratio more in keeping
with other reports in the literature. Excluding those cases, however, would

CHART II

Presentation brow

METHOD OF DELIVERY

Cesarean section

Craniotomy

Diihrssen's incisions and Mid forceps as
such

Flexed Rotated and Low forceps

Spontaneous as such

(Del. Later — Low forceps) Flexed and

Scalp Clamp

Low Forceps as such

Converted to R.M.A. and Low forceps. . .
Flexed and Mid forceps

Total

None
None

3
2 died

None
None

1
Spastic Para-
plegia
1
3
Idied

1
1

STILLBISTHS

2 or 50%

1 or 33.3%

3 or 18.7%

also make the authors' statistics for brow presentations far more formidable,
with a stillbirth rate of 27.2 per cent rather than 18.7 per cent. As it stands
the total fetal mortality for brow presentations is in this series lower than
the total fetal mortahty of 19.04 per cent for face presentations. Efforts at
converting the brow presentation in mid pelvis were made 6 times and
accomplished only twice. Thus again is evidenced the difficulty in master-
ing the actual techniques of conversion. Probably a brow presentation
arrested in mid pelvis should be delivered abdominally as DeLee and
Greenhill (2) advise.

SUMMARY

1. Face presentations 51

Premature 5

Monsters 4

SEEGAR—FACE AND PERSISTENT BROW PRESENTATIONS 97

Term deliveries 42

Brow presentations 16

2. Incidence

1 face presentation to 552 births

1 brow presentation to 1760 births

Corrected incidence excluding monsters

1 term face presentation to 633 term deliveries

1 premature face presentation to 313 premature deliveries

1 term brow presentation to 1,662 term deliveries

3. Mortality

Per cent

Maternal Face and brow 0

Fetal mortality

Mentum anterior and transverse 12

Mentum posterior 29. 4

Brow 18. 7

4. The incidence of contracted pelvis among primigravidas with face
presentations was 31.8 per cent.

5. There were no contracted pelves with brow presentations.

6. There were large babies in 28.5 per cent of face presentations and 25
per cent of brow presentations.

7. There was a spontaneous delivery of one case of mentum posterior
as such.

8. There was no record of a diagnosis of face or brow presentation by
abdominal examination.

9. Prolonged labor was noted in brow presentations in both primigravidas
and multigravidas and in primigravidas with mentum posterior presenta-
tions.

10. Twenty-three and eight tenths per cent of face presentations were
sectioned, while no brow presentations were so delivered.

11. Conversion to an occiput position was attempted in 11 cases of face
presentation and was successful in only 4.

12. Efforts to convert brow presentations arrested in mid pelvis to
occiput positions were made 6 times and accomphshed only twice.

13. One out of 3 infants, delivered from below with a mentum posterior
presentation, died.

14. Section in early labor of all cases with a mentum posterior presenta-
tion would have increased the incidence of cesarean section in the clinic
by only 0.04 per cent.

CONCLUSIONS

1. Prematurity should be noted as an etiologic factor for face presen-
tations.

98 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

2. There is a high incidence of contracted pelvis in face presentations,
particularly among primigravidas.

3. Abdominal diagnosis of face and brow presentations is difl&cult and
infrequent.

4. There is no adequate proof in the literature that many face presen-
tations are, in early labor, brow presentations which convert to face presen-
tations.

5. The techniques of converting face and brow presentations to an occiput
appear far more difficult in practice than in theory.

6. Methods of conversion from below in early labor with a partially
dilated cervix are extremely difficult and carry increased risk to the baby.

7. The occurrence of face presentations appears to be far less frequent
than previously supposed.

8. Section of all mentum posterior presentations in early labor would
greatly decrease the fetal mortality in this condition, while only increasing
the incidence of cesarean section by a negligible degree.

9. The occurrence of face presentation, particularly of the mentum
posterior variety, is not frequent enough to afford many obstetricians the
opportunity to become proficient in the difficult methods of conversion.

BIBLIOGRAPHY

1. DeLee, Joseph B. and Davis, M. Edward: The Treatment of Face Presentation,

Inter-State Postgraduate Medical Assembly of North America 5: 282, 1930.

2. DeLee, Joseph B. and Greenhill, J. P.: Principles and Practice of Obstetrics.

9th Ed., Philadelphia, W. B. Saunders, 1947.

3. Gasparri, F.: On Face Presentation, Ginecologia 3: 837 (Nov.) 1937.

4. Knebel, R.: The Treatment of Mentoposterior Face Presentation, Zentralbl. f.

Gynak. 65: 1821 (Oct. 1) 1941.

5. Krehninger and Guggenberger: Brow Presentations, Arch. f. Gynak. 137: 838

(Nov.) 1929.

6. Maret, C: Brow Presentation,, Gynec. et obst. 20: 91 (July 1) 1929.

7. McCoRMiCK, Charles O.: Pathology of Labor, the Puerperium, and the Newborn,

2nd Ed. St. Louis, C. V. Mosby Co., 1947.

8. Mussio, John G. and Walker, Howard L.: Treatment of Posterior Face Presen-

tations, Am. J. Obst. & Gynec. 41: 88 (Jan.) 1941.

9. Neumann, Hans Otto: DeUvery in Brow Presentation, Arch. f. Gynak. 135: 334-365

(Jan. 9) 1929.

10. PosNER, A. C. AND BucH, I. M.: Face and Persistent Brow Presentations, Surg.,

Gynec. & Obst. 77: 618 (Dec.) 1943.

11. Reed, Charles B.: Persistent Mentoposterior Positions, Am. J. Obst. 51: 615 (May)

1905.

12. Skeel, A. J. : Comphcations and Treatment of Face Presentations, Ohio State M. J.

8: 411 (Aug.) 1912.

13. Wery and Kridelka: Primary Face Presentation, Bruxelles-med. 14: 1124, 1934-

1935.

14. Willlaus, J. Whitridge: Obstetrics, 5th Ed. New York, D. Appleton Co. 1927.

THE USE OF STREPTOMYCIN IN TUBERCULOUS PERITONITISf
A Report of One Case

JOHN MACE, Jr., M.D. and LAWRENCE MARYANOV, M.D.

CAMBRIDGE, MARYLAND

Until the discovery of streptomycin, the treatment of tuberculous peri-
tonitis consisted of general supportive measures, the simple opening of the
abdomen with aspiration of the peritoneal fluid if the process were diffuse, or
removal of an intraperitoneal focus of infection if one were present.

In 1944 Feldman and Hinshaw (1) reported the ability of streptomycin to
suppress the growth of Mycobacterium tuberculosis in guinea pigs. Since
that time many investigators have shown that streptomycin can suppress a
tuberculous process. Therefore, it seems worth while to report a case of
diffuse tuberculous peritonitis, with complete clinical arrest following the use
of streptomycin after other measures had faUed.

This report is offered in the hope that the authors' experience may be of
some aid. The authors consider that this case demonstrates that strep-
tomycin may alter the course of tuberculous peritonitis.

The patient was a 37 year old colored male who was admitted to the Cambridge Mary-
land Hospital November 25, 1947 with a tentative diagnosis of tuberculous peritonitis.
About four weeks prior to admission, he first complained of abdominal pain, fever and
sweating. He noticed that his abdomen was becoming larger but that he had lost weight.
His symptoms became rapidly worse, with nausea and vomiting.

Upon admission to the hospital, his temperature was 102, his pulse 120. There was
marked abdominal distention with generalized tenderness and moderate rigidity. The
patient was dyspnoeic, acutely ill and sweating profusely. The blood findings were
essentially normal: red blood count 4,180,000; hemoglobin 94 per cent; white blood count
6,800; differential neutrophils 80 per cent; monocytes 18 per cent; others 2 per cent. The
urine was negative.

For one week the patient was treated symptomatically with the administration of
adequate intravenous fluids. There was no improvement. On December 3, 1947 an
exploratory laparotomy was performed by the senior author. A low midline incision was
made and the peritoneal cavity opened, disclosing discrete tubercles thickly studded in and
beneath the peritoneum on all abdominal viscera. There was a large quantity of a straw
colored slightly turbid effusion. After aspiration of the fluid, the abdomen was closed.
The diagnosis at the time of the operation was diffuse tuberculous peritonitis. This was
confirmed by a section sent to the Pathologic Laboratory of the University of Maryland
Hospital.

There was no improvement after the operation. The temperature continued between
101 and 103 with a rapid, weak pulse; and the patient suffered from toxemia with nausea,
vomiting and profuse sweating. The abdomen was markedly distended.

t Received for publication May 26, 1948.

100 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Five days after the operation, streptomycin was begun, .3 gm. at intervals of three
hours. For several days the patient's temperature fluctuated but continued steadily
downward. The nausea and vomiting quickly subsided as did the toxemia, and the patient
was taking food and fluids easily. In ten days all abdominal pain and distention had
completely cleared, and the sweating ceased.

After thirty days of streptomycin treatment, he was discharged from the hospital as an
ambulatory patient. During the last two weeks of treatment, he was entirely symptom
free. One month after discharge he was examined and found to be in excellent condition
with a temperature of 98.4 and a pulse of 76. He had gained 12 pounds and his abdomen
was soft and flat. He had resumed his regular occupation as a farmer. Another recheck
on May 16, 1948 revealed his condition to be unchanged.

At this time it is diflScult to determine whether the laparotomy was a
factor in the arrest of the condition or whether this arrest can be attributed
to streptomycin. In view of the continuance of the symptoms and signs
after laparotomy, and the almost immediate response to streptomycin
therapy, the authors believe that streptomycin was the deciding factor in
the arrest of this condition. The drug was well tolerated during the long
course of treatment, and there were no untoward reactions.

BIBLIOGRAPHY

1. Feldman, W. a. aistd Hxnshaw, H. C: Effects of Streptomycin on Experimental
Tuberculosis in Guinea Pigs, Proc. Staff Meet., Mayo Clinic 19: 593 (Dec. 27) 1944.

FROZEN SECTION SERVICE IN BREAST SURGERY
AT THE UNIVERSITY HOSPITAL

A Report*!

WILLIAM L. BYERLY, M.D. and DEXTER L. REIMANN, M.D.

BALTIMORE, MARYLAKB

In over 14 per cent of a series of 321 breast lesions removed during the
five years from 1943 to 1948 at the University Hospital, Baltimore, Mary-
land, staff surgeons were unable to differentiate benignity and malignancy
accurately. Malignant tumors were called benign in 8 instances, and 9
benign lesions were erroneously diagnosed as malignant. In 29 instances
the surgeon, being uncertain as to the diagnosis, refused to commit himself.
In this same series, an error of 1.2 per cent was made by the pathologist after
viewing the frozen section. Uncertainty existed in the pathologist's mind
in 1 of these cases. Two malignant tumors were reported as benign and 1
benign tumor as malignant.

The 4 errors made at frozen section were in cases of intraductal papillomas.
In 2 cases, hyperplastic duct epithelium gave a pseudo-malignant appear-
ance. It was noted that this source of error was avoided by the pathologist
of greatest experience. The cause for error was unusual changes in the duct
epithelium. Here, an erroneous diagnosis of malignancy was influenced by
the history, the age of the patient, and the atypical appearance of the h)^er-
plastic epithelium. In the 1 case, where a malignant tumor was reported
as benign, the error resulted from poor selection of tissue for the frozen
section. Of the many papillomas seen 1 was malignant. In this case, an
error of diagnosis was made.

CHART I

Percentage of errors for clinical impression and frozen section based on permanent sections

NO.
BENIGN

ERROR

NO.
MALIG-
NANT

EEROR

NO.
UNDE-
CIDED

ERROR

TOTAL ERROR

No.

Per-
cent

No.

9
1

Per-
cent

No.

Per-
cent

No.

46
4

Per-
cent

Clinical Impression.
Frozen Section ....

195
220

2.5
.6

97
100

2.8
.3

14.3
1.2

Total Number of Cases 321

* From the Departments of Surgery and Pathology, School of Medicine, University' of
Maryland.

t Received for pubHcation August 2, 1948.

101

102

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

CHART II

The lesions in which errors were made

FROZEN SECTION DIAGNOSIS

CORBECTED DIAGNOSIS BY PERMANENT
SECTION

S.P.
S.P.
S.P.

7^48250

#50280

#55603

*Benign Intraductal Papilloma
Benign Intraductal Papilloma
Intraductal Papillary Carci-
noma

Benign Intraductal Papilloma
Intraductal PapillaryCarcinoma
Benign Intraductal Papilloma

S.P.

#59260

Benign Intraductal Papilloma

Intraductal Papillary Carci-
noma

* Final Diagnosis was withheld twenty-four hours.

Misdiagnosis by the clinicians resulted from a confusion of those signs
which are attributable to both benign and malignant tumors. Two cases of
fat necrosis were considered malignant. This impression was based upon
the firmness of the scarred mass and its relative fixation to the surrounding
stroma. Contraction of the collagenous tissues led to dimpling of the skin
and retraction of the nipple. For similar reasons, an organizing hematoma
and a chronic suppurating lesion were called malignant. Other errors were
made in evaluating small, early, deep tumors in young adult females. In
this group, erroneous diagnoses of benignity were recorded because of the
apparent mobility of tumors which were in truth malignant. In 1 case, an
inflammatory carcinoma was listed as benign on the basis of obvious char-
acteristics of the inflammatory state.

POLLEN COUNTS*t
HOWARD M. BUBERT, M.D. and SELMA ROSENBERG GOLDSMITH, A.B.

BALTIMORE, MARYLAND

Beginning with the July 1938 number of this pubhcation (1), the Depart-
ment of Allergy of the School of Medicine of the University of Maryland
began publishing pollen counts for this area. These have appeared yearly
except for the war years 1942 through 1946, when it was necessary to dis-
continue the work because of lack of personnel. Counts were started agala
in 1947, and the report upon that year is given herewith.

P Pollen RT R^in (Precipitation) /'Ragweed Onlv^

W Wind Velocity B-- Barometric Pressure VSTARrED/AuGl9/

P W

iOO 2G ,.j

250 22* A'":

125 17 /

75 15-

30 12
10 10

Apr8 10 12 14 re 18 20 ZZ 24 26 28 5QM

m 26.,
250 22 \

125 ny\i,y.tf'^^"'iry

75 15 '*'

/W25 27 29 SIJjnZ 4 6 8 10 12 14 15 18 20 22 24 26 28 SOJuJ.

400 26

250 22 /

125 17::,>,<"'"

75 I5t

R B

2D0 5a40
M20

J 3 29.50
.05 29.50

II 15 15 17 19 21 23

30.40
j.' too 5020

,.. .55 50.00
.55 2380

.15 29.50
D5 2830

3 5 7 9

30 12
10 10

400 26
250 2L

125 17
75 15

Aug 27 23 31 Sep;

200 5040
lilO 3020

.55 30.00
.35 29.80

.15 2a50
D5 29.50

200 5040
100 3020

.55 3000
.35 2930

J5 2950
.05 2930

One item of outstanding interest deserves mention. On September 21,
1947, the mean temperature was 72 degrees F,, and within forty-eight hours

* From the Department of Allergy, School of Medicine, University of Maryland,
t Received for publication April 29, 1948.

103

104 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

it had dropped to a mean temperature of 52 degrees F. During the forty-
eight hour period in question there was a precipitation of .35 inches with a
maximum wind velocity on September 21 of 22 miles per hour and on
September 22 of 26 miles per hour. Abruptly many asthmatics began to
have asthma, and a considerable proportion of them went into status asth-
maticus of a severe grade and required hospitaUzation. The public press, in
commenting later upon the pollen season, quoted some well-known observers
to the effect that the pollen season had been quite severe, and attention was
called to this flare-up of asthma. In the opinion of the authors, this reason-
ing is completely fallacious and unfounded. The pollen counts for the two
day period in question were very moderate, as can be seen by referring to the
chart shown above. Actually, the poUen practically disappeared a day or
two after the forty-eight hour period in question, but the asthmatics con-
tinued to have symptoms over a period varying up to two weeks in length.
The authors believe that the sudden drop in temperature, the precipitation,
and the very real wind velocity were the aggravating factors and that pollen
had nothing to do with the appearance of severe asthma. They are at a loss
to understand the explanation given in the public press, because they believe
that it is completely illogical. It may be mentioned also that no exacerba-
tion of hay fever S3miptoms occurred, and this most certainly would haVe
happened had the pollen been the causative agent.

METHOD

The method used in previous years was employed again this year (2).

Even though a great deal of work is being done on pollen counts at the
present time, the authors concur in the opinion offered by the Pollen Survey
Committee (3) and consequently have continued to use one square centi-
meter as the unit of measurement. This will be altered if future experience
indicates that such a change is in order.

BIBLIOGRAPHY

1. BuBERTjH.M. AND Rosenberg, S.: Pollen Counts, Bull. School Med. Univ. Maryland

23: 15, 1938.

2. BuBERT, H. M. AND ROSENBERG, S.: Pollen Counts, Bull. School Med. Univ. Maryland

23: 179, 1939.

3. Preliminary Report of the National Pollen Survey Committee of the American Academy

of Allergy on Proposed Standardization of Pollen Counting Techniques, J. Allergy 2:
178, 1946.

DEPARTMENT OF OBSTETRICS

Case Report*!

O. M., a 32 j'ear old, para 1-0-0-1 was admitted to the hospital on July 13, 1948, near
term although not in labor, with abdominal pain and a transverse presentation. The last
menstrual period had been October 7, 1947. Fetal movements were felt in February 1948.
The estimated date of confinement was July 14, 1948. In November, at the time of the
expected menses, the patient had cramp-like abdominal pain with a brownish vaginal
discharge. On December 14, she was seized with severe, sharp, intermittent left lower
quadrant pain with a sense of faintness but no sjoicope and no vaginal bleeding. She was
treated by her physician with sedatives and had to remain in bed for twentj^-five days.
The diagnosis at that time was "inflammation of the left tube and ovary". In February,
an examination revealed a pregnancy. For two weeks prior to admission to the hospital,
the patient had severe abdominal pain with fetal movements. An examination at this
time revealed the fetus Ijong in a transverse position with the fetal parts close to the
abdominal wall and easily felt. Numerous attempts to elicit Braxton-Hicks contractions
were unsuccessful. A roentgenograph of the abdomen on July 14 showed the fetus to
lie as a transverse presentation with the fetal back directed toward the mother's diaphragm
and the small parts "dangling" into the pelvis. A repeat roentgenograph on July 16
showed the fetus now to be lying in an oblique position with extreme extension of the
vertebrae and the head. Placentography failed to visualize the placenta. A pelvic
examination showed the cervix to be long, the external os tightly closed; and no pelvic
mass aside from pregnancy was determined.

DISCUSSION

The history of pain at the first missed period, the severe attack of left
lower abdominal distress, with a feehng of faintness requiring sedation and
bed rest for twenty five days, and then a definite diagnosis of pregnancy
present a typical history of a ruptured ectopic pregnancy resulting in a
secondary abdominal pregnancy. The later development of severe abdom-
inal pain with fetal movements, the extreme abnormal presentations as
shown by roentgenograph, and the inabihty to visuahze the location of the
placenta, the long, closed cervix in a multigravida, and failure to eUcit
Braxton-Hicks contractions are all typical signs of abdominal pregnancy.
To make the diagnosis even more certain a uterogram might have been em-
ployed to show that the uterus was empty, and the tokodynamometer to
show that there were no uterine contractions, but these were considered
unnecessary.

MANAGEMENT

A laparotomy was performed on July 17, 1948. The patient received 750
cc. of whole blood. An abdominal pregnancy was found, and a full term,

* From the Department of Obstetrics, School of Medicine, University of Maryland.
t Received for publication August 31, 1948.

105

106 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

living, female child was extracted. The placenta was attached to the pos-
terior portion of the uterus and left broad hgament. No attempt was made
to separate the placenta, but the cord was tied with nonabsorbable suture
about 5 cm. from the placenta, and the abdomen was closed without drain-
age. The patient did well postoperatively, and both mother and baby were
discharged from the hospital in good condition on the eighteenth day.

It is important to stress the handling of the placenta in these cases; one
must never attempt to separate it, because bleeding from the placental site
is usually profuse and uncontrollable. The placenta thus left in place will,
in the course of time, become absorbed, and will cause no difficulty later.

ALUMNI ASSOCIATION SECTION

DR ARTHUR MARRIOTT SHIPLEY
RETIRES AS PROFESSER OF SURGERY

On July 8, 1948, Dr. Arthur Marriott Shipley retired, after twenty-eight
years as Professor of Surgery and forty-six years as a teacher at the School
of Medicine of the University of Maryland.

Dr. Shipley was born at Harmans, Anne Arundel County, Maryland, on
January 8, 1878. He attended the Friends School in Baltimore and in 1902
he graduated from the University of Maryland School of Medicine as the
honor man in his class. He interned on Dr. Tiffany's and Dr. Martin's
services, and for a year was Assistant Resident in Surgery. He then went
abroad with Dr. Gordon Wilson (later Professor of Medicine) for a winter
of post-graduate work in Germany. From 1904 to 1908 he was Medical
Superintendent of the University Hospital. He was Associate Professor
of Surgery from 1907 to 1914, when he became Professor of Clinical Surgery.
During the first World War he served in the Medical Corps of the United
States Army from 1917 to 1919. He was Chief of the Surgical Service in
Evacuation Hospital 7^8 in France and rose to the rank of Lieutenant
Colonel. In recognition of his fine war record, he was cited for the Dis-
tinguished Service Medal. After his return to the Medical School he was
appointed in 1920 to the Professorship of Surgery.

Dr. Shipley's career as Head of the Department of Surgery covered an
important era in the history of the Medical School. When he accepted the
chair of Surgery the School had not yet recovered from the disorganization
incident to World War I. Its integration with the other schools of the
newly constituted University of Maryland was still incomplete. The lines
of authority in the new University were ill-defined. The faculty of the
Medical School was suffering from the loss of important senior members
through age, and many able younger men were seeking greater opportunities
elsewhere. The Medical School was handicapped by old and ill-equipped
laboratory buildings, an outdated hospital and parsimonious support from
the state.

This period was one demanding fortitude on the part of the faculty and
calling for leadership, especially from those in positions of authority.
Among the group heading the advance Dr. Shipley was included from the
first. The passing years recorded the long struggle which eventuated in
the building of the new University Hospital, the new Nurses Home, the
Bressler Building for research, the re-equipment of the laboratories, the

107

DR. ARTHUR M. SHIPLEY

108

NEWS ITEMS 109

strengthening of the faculty and, finally, the greatly increased annual sup-
port from the state legislature. The credit for these achievements must be
divided among many men, but it should be recorded that to everj^ effort
made for the betterment of the School Dr. Shipley contributed freely of his
time and energy and stood out as a natural leader of the faculty.

The Department of Surgery which Dr. Shipley took over in 1920 was a
department of general surgery. The development of the surgical specialties
in the University of Maryland Medical School was in its infancy as com-
pared to the leading medical schools of that day. Faced by limitations in
the number of surgical beds and by a small department budget, it proved a
long and difficult task to expand the work of the Department of Surgery to
cover all the important sub-departments, such as neuro-surgery, genito-
urinary surgery, orthopedics, chest surgery, vascular surgery and plastic
surgery which have been added to it in the period of Dr. Shipley's adminis-
tration.

Dr. Shipley's own reputation as a surgeon grew rapidly through the years.
Quite early it became national rather than local. It was solidly founded on
his broad knowledge of surgical anatomy and pathology, on his careful
analysis of his very extensive clinical experience and on constant contact
with the advances of knowledge in the surgical field. He has been dis-
tinguished by his diagnostic acumen and the excellence of his judgment at
the operating table. His special interests have been varied. His early
contributions to the surgery of lung abscess and suppurative pericarditis
were followed by many publications from his service in the field of abdom-
inal surgery. His name is associated with the earliest planned removal of
a pheochromocytoma and resultant cure of the type of hypertension caused
by this tumor.

The Alumni of the School of Medicine who are the readers of the Bulletin
have for the most part sat under Dr. Shipley in the surgical courses. To
them his chief eminence is as a teacher. They have borne witness to this
by inviting him innumerable times to all parts of the country to address the
medical societies to which they belong. It may well be that their judgment
is the correct one and that the greatest contribution to medicine that Dr.
Shipley has made during his long and diversified career has been what he has
taught to his students and to his assistants. Certainly, he loved to teach
and is a gifted teacher, holding the interest of others because of his own in-
terest, driving home a point with a vivid phrase, drawing on his wide clinical
experience for examples, stressing the need of judgment. Those who have
heard many teachers rank him with the best.

Holding as he did for many years the position of Chief Surgeon in the
Baltimore City Hospitals as well as in the University Hospital, Dr. Shipley
directed the training of an unusual number of surgical residents. The value

110

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

of this training has been well demonstrated, both by the later careers of the
men who have worked under him and by the constantly increasing number
of applicants for surgical residencies in his Department.

One feature of the testimonial dinner which was given to Dr. Shipley
last year when he approached the age of seventy was the long table occupied
by former residents who had gathered from far and wide to do honor to their
former Chief.

The University takes pride in the widespread recognition of Dr. Shipley's
eminence as a surgeon, in his election through the years to every national
surgical society of importance, in the throng of patients who came to consult
him, in his position in the Medical and Chirurgical Faculty of Maryland as
Councilor and President and in his many services to the city of Baltimore
and to the nation in two wars. He will be ranked in the history of the
Medical School with those leaders in the past who have maintained the
highest traditions of this institution.

In new pursuits and in well-earned leisure may many happy years
await him.

PRESENTATION TO THE MEDICAL LIBRARY

The presentation of a complete file of the Journal of the Alumni Association of the Col-
lege of Physicians and Surgeons to the Medical Library by Dr. Harvey G. Beck. L^t
to right: Dr. H. Boyd Wylie, Dr. Wetherbee Fort, Dr. W. Wayne Babcock, Dr. R.
Sumter Griffeth, Dr. Harvey G. Beck.

Dr. Harvey G. Beck, Professor of Clinical Medicine, Emeritus, has pre-
sented a complete file of the Journal of the Alumni Association of the College
of Physicians and Surgeons to the Medical Library of the University of
Maryland. This journal was published quarterly from 1898 until 1915.
In 1898 Dr. Harry Friedenwald was the president of the Alumni Association,
and the idea of establishing a journal was a part of his program for the
advancement of the Association for the interests of the College.

NEWS ITEMS 111

DR. CARL L. DAVIS
RETIRES AS PROFESSOR OF ANATOMY

At the conclusion of his last class in May, Dr. Carl Lawrence Davis,
Professor of Anatomy, Emeritus, received a farewell testimonial, presented
by Dr. Charles Bagley Jr., Professor of Neurosurgery, in behaK of the
members of the Class of 1950 and the Department of Neurosurgery.

Dr. Davis, a graduate of George Washington University Medical School,
served as a professor of anatomy at that institution from 1914 until 1919
when he came to the University of Maryland as Professor of Anatomy.

The gift presented to Dr. Davis was a complete set of Arnold J. To3aibee's
A Sttidy of History.

Dr. Davis receiving from Dr. Bagley the farewell testimonial from the Class of 1950
and the Department of Neurosurgery.

112 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Dr. Robert Walker Love (B.M.C. 1897) was honored by Hardy County,
West Virginia with a reception on July 16, 1948, where he was presented with
a silver tray. Dr. Love interned at Maryland General Hospital, and has
taken post graduate courses at Johns Hopkins, Harvard and the University
of Pennsylvania. He has practiced in Moorefield, West Virginia, for forty-
five years.

Dr. Theodore E. Woodward (U. of Md. 1938), Assistant Professor of
Medicine, represented the University on the Malayan expedition of the
Army scrub typhus team this spring. Dr. Woodward was invited to join
this expedition because of his wide experience with typhus during the war.
At that time the University of Maryland requested to sponsor the under-
taking. It was this expedition which discovered the value of the drug
Chloromycetin in combating not only typhus but typhoid fever, a discovery
which has been widely hailed since its announcement.

Dr. Walter Stevenson was elected president of the Illinois State Medical
Society at its last meeting. He will take ofl&ce in 1949.

Dr. Gilbert L. Dailey (U. of Md. 1914), Chief of Staff at the Harrisburg,
Pennsylvania, Hospital was recently elected President of the Pennsylvania
Academy of Ophthalmology and Otolaryngology.

NOTE ON THE INCEPTION OF THE ASSOCIATION OF AMERICAN MEDICAL

COLLEGES*

To the Editor: — In 1890 while studying abroad I received letters from my
father. Dr. Aaron Friedenwald, professor of ophthalmology in the College
of Physicians and Surgeons of Baltimore. The following excerpts throw an
interesting hght on the creation of the Association of American Medical
Colleges. Excerpt from the letter dated Jan. 30, 1890:

Dr. Cordell has stirred up the profession in Baltimore in reference to the Colleges raising
their standard. The University of Maryland a few weeks ago announced that from the
next session a compulsory three year graded course would be adopted. Dr. Latimer and
I were appointed a committee to represent the College of Physicians and Surgeons at a
meeting (of the faculty) held last week. I took the ground that the simple adoption of a
three years' course by the colleges of this city might not accomplish at all what the pro-
fession seemed so much to desire. I could imagine a result which would attract the
students, who would be prevented by such an action to come to Baltimore, to colleges whose
requirements were not so high. In such a case, the profession at large would not be
benefited, but very probably the college might be made to suffer to an extent that would
greatly endanger its existence. I therefore preferred that a circular should be sent to all

* Reprinted from J. A. M. A., April 3, 1948.

NEWS ITEMS 113

colleges of the United States having a two years' course (asking them) to send delegates to
the meeting to take place in Nashville (Tenn.) in May next, when the American Medical
Association will meet there, for the organization of an Association of American Medical
Colleges, whose purpose it shall be to elevate the standard by a concert of action; the
delegates sent to this meeting to be instructed to vote for a three year graded course. I
think the time an opportune one to bring about this result. It is true that a similar effort
ended in failure about twelve years ago. The vis a tergo in the shape of the state medical
examinations, which so many states have adopted, did not exist at that time, and it seems
to me the best way out of the difficulty. My proposition met with favor, and tomorrow
there will be another meeting to consider the circular, the preparation of which has been
entrusted to Dr. Cordell. If this effort will be successful, it will be a great achievement,
and our college will have the credit of first proposing a practical method of disposing of this
vexed question.

Excerpt from letter dated Feb. 9, 1890:

On last Thursday a meeting of the representatives of the various medical colleges in
Baltimore took place and my proposition to send a circular to all medical colleges in the
United States for a meeting in Nashville in May, to raise the standard of medical education
by a concerted movement was adopted. I hope that this will lead to something.

The call for the meeting went out over the signatures of A. Friedenwald,
chairman, and E. F. Cordell, secretary. The former was elected vice chair-
man of the newly formed association.

Harry Friedenwald, M.D., Baltimore

NOTICE

By action of the General Alumni Association in June, 1947, the annual
Alumni Honor Award was created. In 1948 this award was presented to
Dr. W. Wayne Babcock in token of distinguished contributions and achieve-
ments in the science of art and medicine.

Within the near future the Board of Directors will again be considering
nominees for the Honor Award for the year 1949. As an Alumnus you are
invited to participate in the balloting by completing and returning to the
Alumni office by January 1, 1949, the form reproduced below indicating your
nominations for the Honor Award.

Your nominations should be based upon outstanding contributions to the
science of medicine, either in the applied field of clinical medicine or in pure
scientific research.

Your nominations will be warmly received and with those of your fellow
Alumni will be used by the Board as a basis for the selection.

To the Board of Directors, Medical Alumni Assn. :

I hereby nominate __^_^__

for the Alumni Honor Award in 1949. for reasons
listed below:
Date , M.D.

114

BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

The presentation of the Alumni Association Honor Award to Dr. VV. Babcock by Dr.
Wetherbee Fort, President of the Alumni Association.

THE CHANGING MEDICAL PATTERN*

W. WAYNE BABCOCK, M.D.

Deeply appreciative of being the first alumnus to be thus honored by our
association, I cannot but feel that others merit precedence. On this, the
fifty-fifth anniversary of graduation form the College of Physicians and
Surgeons, my mind turns to the careers of classmates, nearly all of whom
have preceded me to another reward. Eighteen ninety-three was the last
of a two years' course in medicine, and of our class of 212, 179 students grad-
uated. Many thought it unwise to turn out practitioners after such a brief
course of training, but the education of a real physician never ends, and the
Baltimore course stimulated many young minds to see that a medical edu-
cation, like AHce in Wonderland, must ever go forward to keep one from
shpping backward. Those two brief years gave members of the class a
running start in a race with the medical progress that never ceases. It
has been said in times past that scholarship in college is a poor criterion of
a successful career after graduation; that the honor student is often im-

* Presented by Dr Babcock on receiving the first annual Honor Award of the Alumni
Association.

BABCOCK— CHANGING MEDICAL PATTERN 115

practical and a failure in later life. I have been interested, therefore, to
learn what happened to those receiving honors at this graduation.

The first prize went to Charles F. Blake, of Ohio, whose distinguished
career as professor in the surgical department of the University of Maryland
is famiUar to you all. We mourn his recent loss. Two second prizes were
awarded, as two roommates, of the same name, from different parts of New
York State, related only through an ancestor ten generations back, had the
same general average. One, Warren L. Babcock, became president of the
American Hospital Association and was a leading authority on hospital con-
struction and direction. He was, during the first World War, in charge of
the largest army hospital in France, and many hospital buildings in Detroit
are monuments to his abihty. The third prize went to Amos W. Colcord,
who became a leading industrial surgeon in western Pennsylvania. The
fourth to James B. McElroy, of Mississippi, who became professor of medi-
cine in the University of Tennessee. Wiliam F. Barry, an honor man, be-
came president of the Rhode Island State Medical Society. In the Ten-
nessee mountains the family of Clarence M. Grigsby were so poverty-stricken
that they shipped him to relatives in Texas. Here, as a young boy he re-
ceived 30 dollars a month for carrying the mail on horseback to an adjacent
county. A loan enabled him to seek his medical education in Baltimore.
He returned to Texas and for many years was professor of clinical medicine
in the Baylor University School of Medicine of Dallas. Many will recall
the late George M. Linthicum, of Maryland, who became professor of proc-
tology in the College of Physicians and Surgeons. I have mentioned only
a few of the almnni of my own class, but I am sure that if each of you could
rise and add names from the more than 141 medical classes of the University
of Maryland, it would constitute an army of individuals who, by
distinguished careers, have honored their ahna mater. I am humbled to ap-
pear as their first representative.

May I now briefly refer to the medical Baltimore of the eigh teen-nineties.
The Association of American Medical Colleges, of which Aaron Friedenwald
our professor of opthahnology was a founder, had been organized in 1890
and medical courses in the eleven medical coUeges in Baltimore, led by the
University of Maryland, were being rapidly lengthened from two to three
to four years in the better schools, while the weaker were being forced to
discontinue. The Johns Hopkins Hospital had opened in 1889 but financial
conditions delayed the opening of the medical school until the fall of 1893,
the first class graduating in 1897.

No medical center in the United States then offered so much in medical
education for so little. Aided by a letter from a preceptor, a medical scholar-
ship for a year could be obtained for sixty-five dollars. A hall bedroom
cost one dollar a week and table board was suppUed for as Httle as two dollars

116 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

and a half. This included cow's liver as the daily source of animal protein,
but we did not at the time appreciate the valuable nutritional elements thus
suppKed. The city water was coffee-colored. Probably it contained no
more typhoid bacilh than that of Philadelphia, where most of the hospital
beds were reserved for t5rphoid patients. Many of us were careful to drink
only boiled city water. We did not then reahze the frequent contamination
of city milk by tubercle bacilli. A few years later about 12 per cent of the
samples of the milk collected from milk wagons on the streets of Philadelphia
produced tuberculosis when injected into guinea pigs, and tuberculous glands
of the neck were very common in the young throughout the United States.

The medical training was largely by didactic lectures, with anatomical
dissections, and amphitheater clinics chiefly in surgery and gynecology.
Ward class and laboratory instruction was beginning to be expanded. As
happened with William Mayo we sometimes answered, by present day stand-
ards, everything wrong yet received a perfect mark.

At the College of Physicians and Surgeons, Thomas Latimer, a native of
Georgia, was the highly respected president of the faculty. He had been
a surgeon in the Confederate Army, a medical surveyor of the Army of
Northern Virginia, professor of anatomy in the Baltimore College of Dental
Surgery; professor of surgery, then of physiology and the diseases of chil-
dren, and finally of the principles and practice of medicine in the College of
Physicians and Surgeons. From 1870 to 1873 he was editor of two medical
journals. Others, like Oliver Wendell Holmes, had also occupied a settee
rather than a single professorial chair. Thus, the versatile and popular
George H. Rohe had been lecturer on dermatology, gynecologist, professor
of therapeutics and mental disease, author of a textbook on hygiene, presi-
dent of the Association of Obstetricians, Gynecologists and Abdominal Sur-
geons, president of the American Public Health Association, editor of several
medical journals, and finally superintendent of the Springview Hospital for
the Insane. Dr. Bevan was professor of surgery; Chambers, of anatomy
and cHnical surgery. Thomas Opie was dean and professor of gynecology;
Preston, of physiology and neurology; Aaron Friedenwald, of ophthal-
mology; Simon, of chemistry; and Kierle, of pathology.

Open afternoon hours enabled us to attend lectures at other medical
schools, particularly the University of Maryland and the Johns Hopkins
Hospital. At the University I heard J. J. Chisholm and F. C. Miles. Both,
Like Latimer, had been surgeons in the Confederate Army; and the dynamic
Chisholm had devised the first army ambulance, and had written a manual
of miHtary surgery which had been the guide of Confederate surgeons. Re-
suming civil practice, he had turned from general surgery, in which he was
a success, to ophthalmology; and had founded the Presbyterian Hospital
for the Eye, Nose and Throat. He was a lucid and impressive lecturer,
adept with blackboard illustrations. Miles, erect, dignified, with a gray

BABCOCK— CHANGING MEDICAL PATTERN 117

goatee like Dean Opie, was every inch a southern gentleman. Previously
he had been professor of anatomy in the Washington University School of
Medicine, and then professor of nervous diseases in this University. His
lectures on physiology were orations that held the students in rapt attention
throughout the hour,

Louis McLane Tiffany, senior Baltimore surgeon, had his premedical educa-
tion abroad, where he also had received honors as an athlete. Becoming a
prominent American surgeon, he had been professor of surgery in the Uni-
versity since 1881. In 1892 he wore a full gray beard, and retained evi-
dences of a powerful physique. At this time caps, masks and rubber gloves
were not generally worn by operators, and beards were somewhat of a prob-
lem. Bevan had his black beard cropped short; others with long beards
finally encased them in sterile cloth bags; but Dr. Tiffany, while operating,
wore his beard hanging in front of his sterilized gown. As I watched him
open a large pleural abscess, a heavy stream of pus struck over the mouth
and flowed, like the oil of Aaron, down his beard. The great respect in
which he was held was then shown by the silence and the serious concern
expressed by the students' faces as, with great dignity, he combed out his
mustache and beard with sterile gauze. Quite in contrast was the hilarious
glee of the student body, at the Jefferson Medical College, when the operator
had a somewhat similar mishap while dilating the sphincters and admon-
ished, ''the first attribute of a sohdier is to stand under fire." In a paper
pubhshed in 1882 Dr. Tiffany had introduced hsterism in Baltimore. He
was consulting surgeon to the Johns Hopkins, and his surgical abihty was
widely recognized.

The surgery of the time was antiseptic rather than aseptic. Bichloride
of mercury had recently come into use and it was freely used to irrigate
both clean and septic wounds. Rubber gloves, introduced to protect the
hands of a nurse from carbohc solution in 1890, were not routinely used by
Hals ted until 1896. The haste and dramatic skill of the preanesthetic days
still lingered in the operative clinics. Blood loss, shock and danger were
believed to increase with prolongation of the operation. Although the
Johns Hopkins Medical School had not yet started, doctors and medical
students were permitted to attend the lectures and clinics given by Osier,
Halsted, Welch and Kelly. Few could then see the reason why Dr. Halsted
worked so deUberately and even used four or five hundred hemostatic forceps
in the removal of a cancerous breast. Why, Dr. Levis and Dr. Deaver, of
Philadelphia, had each removed such a breast in less than three minutes!
The noted gynecologist, Joseph Price, on seeing Dr. Halsted operate, is said
to have remarked, "If that woman dies it will be because she has been bitten
to death by all those forceps." Price an advocate of simpUcity, successfully
operated in the homes of several thousand patients, using a plain board or
kitchen table to support the patient, and a small handful of instruments

118 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

that had been steriHzed by being thrust into the open top of a boiHng tea-
kettle. His diagnostic methods were equally simple. Yet a more careful
technic, as practiced by Halsted, as weU as better anesthesia, asepsis and
the hemostatic forceps, were needed to enlarge the boundaries and increase
the safety of operations. Indeed it is my impression that technical im-
provements have been at least as important as antiseptic and aseptic
methods. The mortahty from poor technic was still too high. In reviewing
the mortahty from the abdominal hysterectomies performed in the preanti-
septic era, I was surprised that so small a proportion perished of sepsis. In
the United States and England, of the reported 30 deaths, a septic cause is
given but for 6, while 21, or 70 per cent, seem to have been due to faulty
operative technic and chiefly post operative hemorrhage. Even in 1892
R. P. Harris, of Philadelphia, had reported 20 cases of cesarian delivery by
the horns of enraged cattle, with a lower mortahty than that from the aseptic
scalpels of contemporary obstetricians.

It was the apphcation of meticulous technics as used by Halsted that has
since led to the great development of cranial surgery by Gushing, and of
additional surgical fields by others; and yet, in 1893, many felt the surgical
zenith had been reached. Erichsen's "Surgery," then the approved text-
book, stated that the art of surgery cannot be perfected beyond certain final
hmits which there was little question had been nearly if not quite reached.
Thirty years before, at the beginning of his surgical career in Edinburgh,
Joseph Lister had been entreated by his father-in-law, the eminent surgeon,
S3nne, not to enter surgery as it offered no chance for advancement. About
a century before. Baron Boyer also expressed about the same opinion; while
Ambroise Pare, greatest surgeon of the sixteenth century, had written: that
he had so certainly reached the limit of surgical achievement that little had
been left for posterity.

No longer does one feel that a finahty of achievement has been reached
by our present generation of physicians. The passing months bring new
and often starthng advances and one looks forward to a never-ending prog-
ress in this broad field. It is said that when WiUiam Osier was asked why
he was leaving his beloved associates in Baltimore, he rephed: "It is because
I am shpping so far behind in biochemistry. But in England I will be dead
before they catch up with me."

For some advancements penalties loom ahead. For example, as we con-
trol infection by suKonamides and other antibiotics, we find strains of bac-
teria, such as the hemolytic streptococci, developing resistance and even
growing luxuriantly in a medium containing a suKonamide or penicillin.
Doubtless new antiseptics, acting within the body, wiU be developed, but
will these also stimulate the development of new and resistant strains of
viruses and bacteria? Also these new protective agents as a rule give but
a temporary protection, and while curative for the first attack, do not leave

BA BCOCK~CHA NGING MEDIC A L PA TTERN 1 19

a lasting immunity and may be less effective for a recurrent illness. The
antibiotic may exact a more or less permanent penalty, as with streptomycin,
which may be helpful in tuberculosis but may leave the ear permanently
damaged. Already antibiotics also are producing perplexing changes in
the symptomatology of infection.

In the past, those without suflB.cient resistance were weeded out; those of
tougher fiber survived diseases which in many cases gave immunity of long
duration, as with smallpox, measles, mumps, chickenpox, and typhoid.
With many of these contagious diseases an attenuated attack produced by
vaccination also leaves a prolonged period of immunity. As we are carrying
a much larger number of less resistant individuals to higher age groups by
antibiotics, specific drugs, vaccination or operation, will the resistant fiber of
the race deteriorate? Likewise, what will result from the present enormous
consumption of coal tar derivatives, and of nicotine when continued over
many years?

For continued advance in research it is very important that laboratories
remain free and independent of government domination. We would not
eliminate government laboratories but they should compete with many in-
dependent ones. The foundations of bacteriology were laid by Robert Koch
in a curtained-off portion of his simple office in a small town in Posen.
Ramon y Cajal, denied the use of the laboratories of University of Spain,
unraveled the intricacies of the central nervous system in his living room.
The Italian group, honored for discoveries as to the transmission of malaria,
had a very primitive laboratory. The compelling demonstration of the
transmission of yellow fever by an Army board occurred in simple huts
erected in Cuba. Thousands of laboratory workers had seen penicillin mold
growing as a contaminant on Petri dishes, but only Fleming sought the
reason why other micro-organisms failed to grow in its vicinity. The most
elaborate laboratory may not be over-equipped, but a very simple laboratory
may house the genius. Both should be encouraged, just as the practicing
physician and specialist should retain that independence which has produced
the most progressive era of medical history.

With the constant research and progress in many medical specialties, there
is strong tendency to increase the requirements for these subjects in the
pregraduate period, crowding the fundamental branches to a minor position.
Or, the fundamental branch is assigned to a professor by reason of his re-
search in that particular field, although he may be fitted only for post-
graduate teaching or investigation. The fundamentals of each important
specialty are desirable before graduation, but to become a specialist one re-
quires much postgraduate study and experience. To correlate and render
attractive a proper groundwork in anatomy, physiology, chemistry, pathol-
ogy or the like, requires an unusually well-informed and brilliant teacher,
yet his reward usually is but a fraction that of his clinical colleague. The fun-

120

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

damental branches while far from stationary are not as a rule subject to such
rapid changes as occur in a specialty. In the latter, part of the teaching
may be quite outmoded during a four years course. Care should be taken
that the fundamentals are not neglected. They should be made attractive
and practical. There should be more men like Professor Ford in anatomy.
And now back to the reason I am here before you ; to express my gratitude
for an honor given me by fellow students. I shall treasure the events of
these two days with two of the outstanding experiences of my professional
life. One was an early appointment as professor of surgery at Temple Uni-
versity, where I have had the privilege of working for forty-five years. The
other, which followed worry over possible failure at the final examination,
was the great thrill of graduating with honor from a School of this great
University.

CITATION OF DR. WILLIAM WAYNE BABCOCK FOR AN

HONORARY DEGREE OF DOCTOR OF SCIENCE,

HONORIS CAUSA

The citation of Dr. W. Wayne Babcock by Dr. H. Boyd Wj'lie

-~Im -w^Ka.

BABCOCK— CITATION 121

Mr. President:

I am happy to present Dr. William Wayne Babcock, a graduate of the
College of Physicians and Surgeons of Baltimore in the year 1893. This
institution merged with the University of Maryland School of Medicine
in 1915.

Early in 1903 Dr. Babcock was appointed Professor of G3mecology and
Obstetrics at the Temple University School of Medicine. Later in the same
year he was appointed Professor of Surgery, a position which he held until
his retirement.

During World War I the candidate was appointed surgical chief of General
Hospital ^ 6 and held the rank of Lieutenant Colonel when discharged in
1919.

Known as a great teacher of surgery in this country and in Central
America, Dr. Babcock's scientific interests have centered about new tech-
niques in surgery and the development of new surgical instruments. More
recently he has directed his attention to research in the treatment of malig-
nant diseases of the large intestine. His contributions to literature comprise
more than four hundred papers dealing with scientific and biographical
studies. He is the author of two textbooks, one of which is widely accepted
as one of the standard works by practitioners and students and he is Surgical
Editor of the Encyclopedia of Medicine.

Dr. Babcock is a member of ten scientific societies and has been president
of two of these. Currently the candidate is surgeon at the Temple Uni-
versity Hospital and active surgical consultant at the Philadelphia General
Hospital.

A man of diverse research interests and technical skills and a true phy-
sician, I have great pleasure in presenting Dr. William Wayne Babcock for
the degree of Doctor of Science, Honoris Causa.

H. Boyd WyHe, M.D.

COMMENCEMENT ADDRESS*
The Sin of Indhterence
LOUIS A. M. KRAUSE, M.D.f

I have been interested in history for many years, and I believe that the
lesson it teaches and the patterns displayed can be applied today as in the
past. There have been about twenty civilizations since the dawn of history,
nineteen of which have come and gone. In each one of these civilized
societies mankind was trying to rise above mere primitive humanity towards
some higher kind of life. One cannot describe the goal because it has never
been reached save perhaps by an occasional saint or sage, man or woman,
but never such a thing as a completely civilized society; nor has any civili-
zation held the ground it had gained in its spiritual advance. All have
broken down and gone to pieces except our present one which is undergoing
rapidly many changes, and I doubt if anyone of our age believes our own
civilization is immune from the danger of suffering a similar fate. It is
curious that everyone of these various cultures was convinced that it was the
only civilized society in the world and the rest of mankind were barbarians,
infidels or untouchables. In other words, they were the 'Chosen People'.
I suppose we are under a similar impression today.

Our Western society has perhaps built a framework within which many
non- Western societies are entering. This framework has not been carried
on or produced with opened eyes of unselfish labor. The most obvious
ingredient in it is technology. We have contracted space and annihilated
time by our means of transportation and communication. In our day we
have become geographically united. What we have failed to produce are
the social adaptations and inventions necessary to meet the changes forced
upon us by our material and industrial progress. We have been living on
spiritual capital for a number of generations past, giving lip service to
Christian belief, but not doing enough Christian practice for the most part.
In the past the encounters of civilizations between each other have given
rise or at least pushed to greater heights the religions of that time, such as
the religion of the Summerians; Judaism and Zoarastrianism resulting from
a clash between the Syrian and Babylonian civilizations; Chinese and Islam
springing from an encounter between Syrian and Greek civilizations. The
future of our society and mankind in this world will rest in a great measure
with the higher forms of religion and ethics and not with the civilizations
whose encounters have brought them into being. May I state the histori-

* Given at the Commencement Exercise of the University of Maryland School of Medi-
cine and College of Phj^sicians and Surgeons, and the University of Maryland School of
Nursing. June 5, 1948.

t Professor of Clinical Medicine.

122

KRAUSE—COMMENCEENT ADDRESS 123

cally undeniable fact that spiritual illumination and grace have been given
to man on earth in successive installments, and in different places. I also
do not believe that the great number of souls born into the world, who have
had no share in this spiritual opportunity, as a result, are spiritually lost.
A pagan, no less than a Christian soul has salvation within his reach. To
me Mahatma Gandhi was no less a child of the living God than you and I
even though he was not a Christian or Jew.

War and class have been with us since the first society to date. These two
plagues have been deadly enough to kill former civilizations, but not deadly
enough to completely remove all traces of them. The lesson of history,
therefore, should be looked upon as a navigator's chart which gives us the
mechanism, if we have the skill and courage to steer a safe course. It is one
of the curiosities of history that we have studied the classics both Greek and
Latin much the same way as the orthodox Hebrew and Christian studies the
law and prophets, the Old and New Testament. In other words, we handle
these great literatures in an entirely different way from the way they were
written and intended to be used in many instances, looking upon them as
something static instead of seeing them for what they are — a record of
human activity with divine inspiration. The danger is that it makes one
inclined to think of life in terms of books instead of vice versa. Rather we
should study them not for their own sake, but because they are the key to
the lives of the people who wrote them. I cannot emphasize too strongly
that the glory and grandeur of God are not like a tale that has been told and
finished in the scripture. It continues in the searching minds of men whose
science every day discovers His laws.

So, I wish to urge that we look at our civilization critically and remember
that when our adversary threatens us by showing up our defects, rather than
scoffing or criticizing our virtues, it is proof that the challenge he presents to
us comes ultimately not from him, but from ourselves. It comes, in fact,
as a result of the recent huge increase of Western Man's control over non-
human nature. This very stupendous material progress gave our fathers
the confidence to imagine that for them history was over. So, when I
think of history I see new meanings in words, and feelings behind phrases
which escaped me before; or until I in my turn have experienced similar
crises that inspired various remarkable truths.

Though I understand all mysteries and all knowledge, and have not love, I am

nothing,

or
What man is there of you whom if his son asked bread will give him a stone, or if

he asks a fish will give a serpent.

There is no respect of persons with God and what is very true, not the
hearers of the law are just before God, but the doers of the law shall be

124 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

justified. This will indicate to you what I believe is your responsibility to
your fellow man.

We are our brothers' keepers. That means that our world should be
constructed along the model that would include peoples of all economic levels
and spiritual levels. There should be no room for class. Our ideals should
be for universal brotherhood. Our influence must come from our interest in
man and we can never compromise these ideals with expediency. The
dictator sacrifices the ideals and scruples. To forget scruples is to lead us to
become dishonest. Man is the end or goal and not the system. The mind of
man under a dictatorship or compulsion cannot improve; it degenerates.
You cannot build character and courage by taking away a man's imagination
and independence. Now, you will ask what can I do at this juncture? Let
me retell a parable of a similar crisis that occurred some 1100 years plus or
minus before Christ. This is related in the Book of Judges, 9th Chapter:

At that time the rightful heir to the chieftainship was being displaced by a
usurper. He recognized that the reason for this was the indifference on the
part of his people, so he told his people that the trees went forth on a time to
anoint a king over them and they said to the olive tree, "Come thou and
reign over us". Now, the olive tree is a productive member of the com-
munity of trees and one would expect it to accept some responsibility besides
its interest in its own personal gain. It replied, "Should I leave my fatness
wherewith by me they honor God and man and go to be promoted over the
trees"? In other words, it refused to accept the challenge and to sacrifice
some of its immediate return for the greater good of the community and
itself. Then the trees went to the fig tree another good productive citizen
of the conmaunity of trees and said, "Come thou and reign over us". But
the fig tree as the olive tree was indifferent to the welfare of others and
replied, "Should I forsake my sweetness and my good fruit and go to be
promoted over the trees"? This is another example of the apparently good
citizen interested only in what he is getting out of life, refusing to sacrifice
some of his immediate compensations.

This is what we do in human society only too frequently when we turn our
eyes from community work, faU to vote at elections and manifest only selfish
interests in our fellow man. One can then picture the embarrassment of the
trees in their search for a king when they then turned to the lesser member
of the community of trees, the grapevine which produces fruit, but is yet
semi-parasitic in the sense that it climbs on others for support. Neverthe-
less, the grapevine evidenced only selfish interests and replied, "Should I
leave my wine which cheereth God and man and go to be promoted over the
trees"? So, a third productive citizen in the society of trees refused to
surrender any of its substance or time for the greater sovereignty of the trees.

In their extremity the trees had to seek a king not amongst the more

KRAUSE— COMMENCEMENT ADDRESS 125

worthwhile members, but amongst the non-producers, essentially the para-
sites. So, they asked the bramble bush to come and reign over them. Do
you think the bramble bush turned the offer down? Indeed, it emphatically
did not. It had nothing to sacrifice or to lose. This is what it said, "If in
truth you anoint me king, then come and put your trust in my shadow and if
not, let fire come out of the bramble and destroy the Cedars of Lebanon".
You notice it has no fruit, yea even worse than that, no substance to offer,
but it asks the trees to put their trust in its shadow. What is more fleeting?
As a worthless individual it even utters threats that unless the good citizens
put their trust in its shadow they will be destroyed by the bramble bush.
So, you see the price of indifference in the welfare of our fellow man and the
plague of parasitism in human society. The parasites amongst human
beings of course, are the idle rich, living on inherited fortunes, the shiftless
poor, the gambler, the thief, etc.

The important point, however, in the parable is not human parasitism.
The emphasis is on what the good citizens should be doing. In other words,
the penalty for indifference on the part of the good people is well illustrated.
Our greatest influence will come from our love of mankind, medically and
otherwise. Never be indifferent to a challenge. It's the indifference of
productive citizens that leads to the unscrupulous leadership that we have
in so many countries today. We encourage this when we do not intelligently
attempt to study the men who are running for office. That is how dictators
eventually come to have power and monopoly of force. Bear in mind, how-
ever, that when you differ you court danger, but we are our brothers'
keepers. I am well aware that you cannot help men permanently by doing
for them what they should and could do for themselves, but I hope you will
develop a higher moral sense of conviction that will preclude any indifference
to human welfare. This is the lesson to be found in the knowledge of history
and science. In the New Testament we have indifference vehemently
condemned in the Book of Revelations, the third chapter, 15th:

'T know thy work, that thou art neither cold nor hot. I would thou wert
cold or hot, so, then because thou art lukewarm and neither cold nor hot, I
will spue thee out of my mouth".

So, may I hope that you will never forget your responsibility not only to
your patient, but to society at large.

"Do not pray for easy lives; pray to be stronger men.

Do not pray for tasks equal to your power; pray for power equal to your

tasks".

REFERENCES

1. The Bible

2. Civilization on Trial, by Arnold J. Toynbee

3. Gandhi and Stalin, by Louis Fischer

OBITUARIES
DR. WILLIAM D. WOLFE

Dr. William D. Wolfe (Class of 1934) died of acute leukemia on June 29,
1948. He was dermatologist at the South Baltimore General Hospital and
a visiting dermatologist at the Johns Hopkins Hospital.

Dr. Wolfe interned at the South Baltimore General Hospital and was
medical resident physician there for a year. Following this he studied in
New York on a fellowship under Dr. George McKee, and practiced at the
Skin and Cancer Hospital in that city. During the war Dr. WoKe served in
New Guinea and the Philippines and was discharged with the rank of major.

OBITUARIES

Babione, Augustus A., Luckey, O.; class of 1903; aged 76; died, February

13, 1948, of carcinoma of the prostate.
Bainter, Robert Bruce, Zonesville, O.; B.M.C., class of 1893; aged 81

died, January 20, 1948, of fracture of the hip.
Betton, George Washington, Jacksonville, Fla.; class of 1895; aged 72

died, March 27, 1948.
Blake, Charles French, Baltimore, Md.; P & S, class of 1893; aged 79

died, March 20, 1948, of coronary thrombosis.
Blue, Rupert Lee, Charleston, S. C; class of 1892; aged 79; died, April

12, 1948, of arteriosclerotic heart disease.
Brown, Walter Herbert, Youngwood, Pa.; class of 1889; aged 79; died

March 4, 1948, of coronary artery disease.
CampbeU, J. Isaac, Wytheville, Va.; P & S, class of 1893; aged 79; died

March 13, 1948.
Cobun, Leonidas William, Morgantown, W. Va.; B.M.C., class of 1898

aged 78; died, February 20, 1948, of cerebral hemorrhage.
Deakjme, Walter Clifton, Smyrna, Del.; class of 1919; aged 56; died

February 11, 1948, of coronary thrombosis.
Hicks, Ira Clay, Huntington, W. Va.; P & S, class of 1898; aged 79

died, March 22, 1948, of multiple injuries received in a fall.
Ledbury, John William, Uxbridge, Mass.; P & S, class of 1905; aged 72

died, February 20, 1948.
Miller, Thatcher, San Diego, Calif.; P & S, class of 1906; aged 62; died

January 29, 1948, of cerebral hemorrhage.
Mitchell, Joseph Henry, Dillwyn, Va.; B.M.C., class of 1895; aged 84

died, Febuary 11, 1948.
Rose, Lonzo 0., Parkersburg, W. Va.; P & S, class of 1901; aged 70

died, February 23, 1948, of hypostatic pneumonia.
Simpson, Furman Thomas, Westminster, S. C; class of 1909; served

during World War I; aged 65 ; died, January 29, 1948, of heart disease.
Walters, Charles Manley, Darlington, N. C; class of 1908; aged 71;

died, February 18, 1948, of a skull fracture received in an automobile

accident.

126

BULLETIN

OF THE

SCHOOL of MEDICINE

UNIVERSITY OF MARYLAND

VOLUME 33 No. 4

PMishers:

Faculty or Physic

University of Maryland

Baltimore

PUBLISHED FIVE TIMES A YEAR
(JANUARY, APRIL, JULY, SEPTEMBER AND OCTOBER)

Lombard and Greene Streets
Baltimore 1, Md.

Entered as second-class matter June 16, 1916, at the Postoffice at Baltimore, Maryland
under the Act of August 24, 1912.

BULLETIN

OF THE

SCHOOL OF MEDICINE

UNIVERSITY OF MARYLAND

Vol. 33 JANUARY, 1949 No. 4

TETRAETHYLAMMONIUM VERSUS NOVOCAINE BLOCK OF

SYMPATHETIC GANGLIA*t

R. M. CUNNINGHAM, M.D.

BALTIMORE, MARYLAND

According to the experimental work of Acheson and Moe (1, 2) and the
clinical studies of Lyons and his co-workers (3, 5), tetraethylammonium
(bromide or chloride) has demonstrated its efficiency in producing blockage
of the autonomic ganglia to a degree comparable to or exceeding that ob-
tained following the usually accepted methods of producing a sympathetic
block (paravertebral novocaine injection or spinal anesthesia).

The drug, which is administered intravenously or intramuscularly, has a
high degree of safety but must be administered cautiously. Friedlich et al.
(4) have recently reported an alarming and severe reaction to it.** That it is
not entirely effectual is not apparent from the literature but is brought out by
the case to be here reported.

Lest the art and technic of paravertebral novocaine block of the sympa-
thetic ganglia be abandoned in favor of the new chemical blocking agent
mentioned, the following case is of interest :

The drug, marketed as Etamonf had no effect on raising the skin tempera-
tures in the lower extremities of a man with severe Buerger's type of disease,
even though it was given intravenously in maximum dosage (500 mgm.)
on three occasions on two different days.

On the other hand, 2 per cent novocaine block of the second and third
lumbar gangUa produced a prompt and sustained rise in the skin tempera-
ture of each foot, as measured by the thermocouple, for forty-eight hours.
Bilateral lumbar ganglionectomy was then done on this patient with the good

* From the Department of Surgery, School of Medicine, University of Maryland.

t Received for publication September 22, 1948.

** Since the acceptance of this article, there has been a fatality reported from the use
of tetraethylammonium. Lasser, R. P., Rosenthal, N. and Loewe, L.: Death following
tetraethylammonium chloride, J. A.M. A. 139: 153, (Jan.) 1949.

I Parke, Davis and Company's trade name for tetraethylammonium.

127

128

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Patient: A. G J>afe: z-(, - f8 a^j^z- 7-.-f3

Dosage : soo /n&/72Ffamo/2,i/2frat/'ey2ous//
Vi.'^ Before f/amo/2 _

T'is-) /5 /7}//j. af>d 30 mm offer fTa/no/?
2-8- i-8 7° (0 ^f-fer novaca/ne f)/oc/( /am/^ar ^a/7f//a, ^''"^■anJ 3'-'^ _
2-J7-f8T°i'-) / (/(7J/S /?osf o/? A^/??^ar ^(7/?^//oj7ec/oj77y;2'"iy/3'L
Room r'(.0 Apprgx. 7S°f a// tesfs

h=-

^58

r:r

F-

■~-

/■

^■^

■-^

■'

,/"

S •56

^ 35

<ii

1-35

"1^2

t^
^'^

^ .C

2-/

•^

*-.

'.*

•

■~^

—

3'"

Media/ lateral Media/ laferal

Tot

Dorsum foot

LEFT 1£G

A chart showing the comparative effects of Etamon, novocaine block and

longer Lef

1 ' " """

Fig. 1.
ganglionectomy (L2 and L3) on skin temperature readings of the left foot and leg. Note
there is practically no effect from Etamon in maximum dosage, and the almost identical
good results of novocaine block and lumbar ganglionectomy.

results predicted by the novocaine block. Had this procedure not been
done and the chemical block taken as final authority, the patient would not
have been given the benefits of lumbar ganglionectomy.

The technic of paravertebral novocaine block is a simple procedure, re-

CUNNINGS A M—TETRAETH YLA MMONIUM VERSUS
NOVOCAINE BLOCK

129

Paf/ent: A. G. Dah : i-g- fs a^j 2-7- fa

Josa^e: soo mGm Ffamon, /nfrai/enoas/y
Tk^) Before ftamon
7°(cj /5 /77//?. and 30 mm after f /am 0/7
z-£0f8T°i'^) After noi/aca/ne NocA' /a/77/>ar ^an^f/'a, z'"^ar,/ 3'''^
2-2ffdT\'^) 3 days post op. /u/n/>c7r ^a/?^//o/2ec/o/ny,^"'^m>/5''
Koo/r2 T'COJpp/ox. 7^-/ n/ffests

■fZ

., ^^

--1

>-•

-■

§55

'■"

.^37

^.5

■^

•^

^35

•il, 3/

>^ "00

—

^ 21

^za

■

^ 27

•

—

•

Medial Idera/ AMiaJ Icferal

Toes

J)orsum foot Jower lej ;

Ti(j. z RIGHT LEG '

Fig. 2. A chart, showing the comparative effects of Etamon, novocaine, and ganglion-
ectomy. This leg was less severely involved than the left. Note again the failure of
Etamon to cause a ganglionic block. A novocaine block of L2 and L3 gave a good response
but less than that after ganglionectomy. Fifteen cc. of 1 per cent novocaine were used in
each of L2 and L3 ganglia, whereas 20 cc. of 1 per cent novocaine were used in each of L2
and L3 ganglia on the left side.

quiring only a special paravertebral needle of 21 or 22 gauge, and success
can be readily obtained with a little practice.

130

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

It can be done safely on ambulatory or out patients (Fig. 3). It is one of
the most valuable diagnostic and therapeutic procedures which is readily

Transverse process

Sympathetio

\fena.
cava

Fig. 3. A diagram showing the technic for paravertebral block of the lumbar ganglia.
It is only necessary to infiltrate L2 and L3 ganglia to obtain a warm foot and leg, since L4
and Lb do not have preganglionic connections to the cord and Li supplies the upper thigh
and internal and external genitalia. (Reprinted from Christopher's Textbook of Surgery,
W. B. Saunders Co., Phila. 1945 — with permission of the publishers).

and easily available for such varied conditions as vasospastic disease (Ray-
naud's, frost bite), occlusive arterial disease with concomitant vasospasm

CUNNINGHAM— TETRAETHYLAMMONIUM VERSUS 131

NOVOCAIN E BLOCK

(embolism, thrombosis, diabetic infections with threatened gangrene), in-
flammatory conditions of the extremities (thrombophlebitis, cellulitis, post-
traumatic vascular spasm), causalgic states and reflex sympathetic dystro-
phies, herpes and even such painful visceral conditions as angina and
pancreatitis.

REPORT OF A CASE

A. G., a 39 year old white male, was first seen in February 1948, complaining of a pain-
ful ulcer of two months duration between the fourth and fifth toes of the right foot.

History: The history revealed that for the past five years he had noted coldness of his
feet and that he would experience pain in the calf of each leg on walking any distance.
In 1944 he developed an ulcer on his left great toe. This ulcer did not respond to conserva-
tive therapy and progressed to gangrene for which an amputation was finally done. He
was hospitalized seven months for this illness. The operative site took one and one half
years to heal completely. He had a chronic, mild epidermophytosis of his feet for many
years. His family and systemic histories were non-contributory.

Habits: He smoked 2 packs of cigarettes daily and drank 7 cups of cofiee. He took
neither alcohol nor drugs.

Present Illness: The athlete's foot and claudication persisted, and a painful ulcer de-
veloped which, during the previous two months, became progressively worse. His fingers
became colder and at times felt almost as cold as his feet. He could walk only one block
before calf pain made him stop and rub his legs. He noticed that his feet became reddish
in color on dependency. The ulcer showed no tendency to heal.

Two months before admission he developed a chest cold, followed b}' pain in the right
side with some shortness of breath. He had no hemoptysis, chills or high fever.

A physical examination on admission to the hospital on February 3, 1948 revealed a
temperature of 99.6, a pulse of 100 and a respiratory rate of 22. The patient did not ap-
pear ill. Examination of the chest revealed absent tactile fremitus at the right base with
a flat percussion note and absent breath sounds, with a few crackling rales at the level of
the fourth rib posteriorly. Above this level the breath sounds were increased. The left
chest, heart and abdomen were normal. The patient had a blood pressure of 120 sj'stolic
over 80 diastolic.

The upper extremities revealed coolness in the fingers of both hands. The color was
normal, and the hands perspired moderately. There was absence of both radial pulses;
the brachial artery was well palpated and not sclerotic. The lower extremities revealed
that the left great toe had been removed at the metacarpo phalangeal joint. The scar
was irregular, lixed, medially located and non-tender. There was an ulcer between the
right fourth and fifth toes at the web space, about .5 cm. in diameter, infected, indolent, and
quite tender, with moderate cellulitis of the fourth and fifth toes. Both feet were cold to
the touch and no pulse could be felt on the dorsum or behind the medial malleolus in either
foot. The popliteals could not be felt bilaterally. The femoral pulses were normal.
Color changes were rubor on dependenc}', prompt but mild blanching on elevation.
There was moderate sweating of both feet and moderate epidermophytosis on the right.

A diagnosis of severe Buerger's disease, with epidermophytosis, and ulcer of the right
foot and right pleural effusion, was made.

Laboratory studies revealed a hemoglobin of 88 per cent, a red blood count of 4.74
million, a white blood count of 9200 with 68 percent segmented forms, 28 percent lymphyo-
cytes, 2 per cent monocytes and 2 per cent eosino])hiies. The urinalyses were normal.

132

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

The blood sugar was 87 mgm. per cent, urea 32.1 mgm. per cent. The prothrombin ac-
tivity was 100 per cent compared to a normal control. The patient's serology was normal.

Fig 4. A roentgenograph of the lumbar spine, postoperatively, showing the silver
clips on the ganglionic chain, proximally and distally to the resected ganglia. This pro-
cedure gives some idea of what ganglia were removed and what their relation was to the
spine.

Thoracentesis revealed 250 cc. of straw colored fluid with a white blood count of 1250 c.
mm. with a specific gravity of 1.016. The cultures were negative, including the tubercu-

CUNNINGHAM— TETRAETHYLAMMONIUM VERSUS
NOVOCAINE BLOCK

133

losis studies. Roentgenograph}' of the chest was interpreted as "pneumonia of the lower
right lung with pleural effusion."

Treatment was begun with bed rest and Burrow's solution dressings to the ulcerated
foot, followed by Iso Par ointment to the epidermophytosis.

On February 6, 1948, 500 mgm. of Etamon was administered intravenously after first
obtaining temperature readings of the feet and legs in a room of approximately 75 F.
Readings taken with the thermocouple before, fifteen minutes and thirty minutes after
Etamon showed no rise in temperature of the feet. This procedure was repeated on two
successive days, again using 500 mgm. Etamon intravenously and without any significant

Fig. 5. A composite photograph of the patient, showing the incisions used and the
dusky, cyanotic feet. Note the amputation of the left great toe.

temperature rise in the feet. The usual visual disturbances and paraesthesias of the tongue
and hands were produced.

On Februar}' 8, 1948 a paravertebral novocaine l^lock, using 20 cc. of 2 per cent novo-
caine in each of the lumbar ganglia L2 and L3, on the left side, was done, producing a prompt
and sustained temperature rise in the left leg and foot with an absence of sweating. This
effect lasted for approximately forty-eight hours. Accordingly on Februarj' 13, 1948 a left
lumbar ganglionectomy through a muscle splitting incision was done under spinal anes-
thesia, removing L2 and L3 ganglia and producing a warm, dry foot. The post operative
course was uneventful.

134 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

On February 20, a paravertebral novocaine block, using 15 cc. of 2 per cent novocaine in
each of the Lo and L3 ganglia, was done on the right side, again with a prompt and definite
rise in temperature, although this was less marked than on the left side. It should be
noted that one quarter less novocaine was used in this block than in the first one.

On February 21, 1948, under spinal anesthesia, a right lumbar ganghonectomy was done,
removing the L2 and L3 gangHa, and producing a warm, dry foot, with a post operative
temperature exceeding the ganglionic block with novocaine (Figs. 1 and 2). The patho-
logic diagnosis after each operative procedure was "sympathetic ganglia, (two)". After
each operative procedure a roentgenograph of the lumbar spine was obtained to show the
position of the silver clips used on the ganglionic chain proximally and distally to the
removed gangha (Fig. 4).

The condition of the patient's chest improved greatly. He was discharged February
25, 1948, ambulatory and feeling well. The ulcer on his foot was greatly improved though
not healed.

During the preoperative as well as the post operative course, the patient was watched
carefully for any signs of thrombo embolic disease, since the "pneumonia" with pleural
effusion could easily have been a pulmonary infarct. Early ambulation and foot exercises
were practiced after each operation, the patient being allowed out of bed the next day, and
fortunately no thrombosis or infarction occurred. Anticoagulation therapy was not used
prophylacticaUy.

The patient was back at work six weeks after the second operative procedure. He was
greatly relieved to have dry and warm feet and legs. The epidermophytosis had disap-
peared, and the ulcer was nearly healed. At the time of this report he is able to walk 1
mile before mild cramping begins in the calf of the legs. He has stopped smoking com-
pletely.

Figure 5 shows the operative scars six weeks after the right lumbar ganghonectomy.
This photograph also shows the dusky discoloration of his toes which, however, is less than
the preoperative appearance.

SUMMARY

Chemical block of the sympathetic ganglia is not entirely satisfactory, and
it is believed that more reports will be forthcoming to substantiate this
opinion.

Local novocaine block of the sympathetic ganglia, properly done, is a safe,
reliable and time-tested procedure for many conditions.

A case is reported, illustrating the failure of Etamon but with excellent
results following novocaine block of the lumbar ganglia.

The removal of sympathetic ganglia is a safe procedure which gives excel-
lent permanent results wherever a novocaine block has demonstrated a
warming and drying effect on the extremity. For the upper extremity
T2 and T3 ganglia are severed from their rami and from the remainder of
the thoracic chain. For the lower extremity L2 and L3 gangha are removed.

REFERENCES

1. AcHESON, G. H., AND MoE, G. K.: Some Effects of Tetraethylammonium on the Mam-

malian Heart, J. Pharmacol. & Exper. Therap. 84: 189, 1945.

2. Idem.: The Action of Tetraethylammonium on the Mammalian Circulation, J. Phar-

macol. & Exper. Therap. 87: 220, 1946.

CUNNINGHAM— TETRAETHYLAMMONIUM VERSUS 135

NOVOCAINE BLOCK

3. Berry, R. L., Campbell, K. N., Lyons, R. H., Moe, G. K., and Sutler, M. R.: The

Use of Tetraethylammonium in Peripheral Vascular Disease and Causalgic States.
A New Method of Producing Blockage of the Autonomic Ganglia, Siu-gery 20: 525,
1946.

4. FiOEDLiCH, A. L., Chapman, W. L., and Stansbtjry, J. B.: A Severe Reaction to

Tetraethylammonium Chloride, New England J. M. 238: 18, 1948.

5. Lyons, R. H., Moe, G. K., Campbell, K. N., Hoobler, S. W., Neligh, R. B., Berry,

R. L., and Rennick, B. R.: The Effects of Blockage of the Autonomic Ganglia in
Man, Preliminary Observations on the Use of Tetraethylammonium Bromide, Univ.
Hosp. Bull., Ann Arbor 12: 33, 1946.

FEMORAL NECK OSTEOTOMY
A Treatment for Severe Slipped Capital Femoral Epiphysis*!

HERBERT R. MARKHEIM, M.D.

BALTIMORE, MARYLAND

Interest has again been aroused in the use of femoral neck osteotomy in
cases of severe sUpping of the capital femoral epiphysis. Recent reports
(1, 2, 3) show series of excellent results from the use of this procedure. The
desire to obtain a better functioning hip has led the surgeon to attack the
problem at the site of the pathology. Surgical correction by the use of
femoral neck osteotomy is the only method that will place the head of the
femur in its proper relationship to the neck in both the antero-posterior and
the superior-inferior plane. A previous paper by Dr. R. B. Mearns (4) of
this hospital stressed the necessity for early diagnosis and treatment. The
purpose of this communication is to demonstrate what can be done for those
cases of severe slipped epiphysis which are seen at a late date, utilizing a
surgical procedure directed at correcting the pathology.

Slipped epiphyses, at this hospital, are divided into three groups: minimal
shpping, moderate sHpping, and severe shpping. The roentgenograph of
the minimal or early slip shows the head beginning to migrate posteriorly
and inferiorly (Figure 1 A and B). Changes in the epiphyseal plate and neck
can be observed. This type can be treated by (a.) bed rest in the hope that
the process will resolve with no further sHpping, or (b.) can be nailed in order
to maintain the position of the head, or (c.) epiphysiodesis may be done to
close the epiphysis. If heahng occurs at this stage, the functional impair-
ment of the hip will be minimal. The only restriction in motion will be a
shght loss of internal rotation. The future aspect of these cases may be
one of arthritis of the hip joint and some degree of coxa vara.

The moderate slipping of the femoral epiphysis shows on roentgeno-
graph a greater degree of both the posterior and the inferior migration of the
head (Figure 2 A and B). If this position of the head is permitted to persist,
it will limit abduction and internal rotation and will result in a painful,
arthritic hip. Attempts at closed reduction will, by trauma, jeopardize an
already precarious blood supply to the head and may result in aseptic ne-
crosis of the head. Indeed many cases are seen where the sHp alone produces
a dead head with resulting changes that resemble Perthes' disease. Correc-
tive subtrochanteric osteotomy of the femur will yield only a greater degree

* From the Department of Orthopedic Surgery, service of Dr. Allen F. Voshell, Kernan
Hospital, Baltimore, Maryland.

t Received for publication October 11, 1948.

136

MARKHEIM— FEMORAL NECK OSTEOTOMY

137

of abduction, affecting in no way the internal rotatory motion. It will not
correct the posterior deviation of the head. However, a good functional hip
can be obtained from trochanteric osteotomy.

Fig. 1. Anlero-]Josterior and lateral views of a mild slipped epiphysis.

The gradual or traumatic sHp of a severe nature when seen after a pe-
riod of two weeks is irreducible, in the author's opinion, by closed methods.
There are those who do not hold with this IjcHef. The head of the femur can

138

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

be seen to be so far posterior and inferior that the neck seems to be articulat-
ing with the acetabulum (Figure 3 A and B). Sufficient callus and fibrous
tissue has formed so that traction is ineffectual and manipulation will only
traumatize the head, producing aseptic necrosis. Trochanteric osteotomy

Fig. 2. Antero-posterior and lateral views of a moderate slipped epiphysis.

will overcome the inferior slip, but the head will still remain posteriorly.
The only rational method to correct this deformity is to restore the head to
its anatomic position. This can be accomplished by osteotomy of the neck
of the femur.

MARKHEIM— FEMORAL NECK OSTEOTOMY

139

The operation has been adequately described by others. Briefly, the ap-
proach is through a Smith-Peterson incision. The capsule is cut in a T-
shaped manner and the head and neck may be visualized by externally

Fig. 3. Antero-posterior and lateral views of a severe slipped epiphysis.

rotating the femur. The neck is osteotomized along the epiphyseal plate
using a curved chisel, or a v^edge of bone may be removed from the neck at
the junction of the neck with the epiphysis. The base of the wedge is
directed superiorly and anteriorly in order that the head may be rotated back

140 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Fig. 4. (Top) An antero-posterior view of patient P. S. on admission.
Fig. 5. (Bottom) Patient P. S. four weeks after the femoral neck osteotomy.
head is restored to its normal position and is held by a Smith-Peterson nail.

The

to its normal position. The head may be fixed to the neck by any of several
forms of internal fixation; the author prefers to use a Smith-Peterson nail.
Light balanced traction is maintained for a period of four weeks during
which time active motion is encouraged. Following this the patient is given

MARKHEIM— FEMORAL NECK OSTEOTOMY

141

physiotherapy and exercise, and crutch walking with no weight bearing is
permitted. Heahng is usually complete in three months.

14 WEEKS POST-OP

Fig. 6. Patient P. S. Antero-posterior and lateral views taken after removal of the
Smith-Peterson nail.

The following case illustrates the advantage of femoral neck osteotomy.

Patient P. S. a fourteen year old white male was admitted to the hospital on Ma_\- 1,
1948. In June 1947 he developed pain in the right hip which was referred to the knee.

142 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

He was seen by his family physician who recommended rest. Pain in the right hip was
intermittent and caused the boy to limp. Eight days prior to admission there was a sud-
den increase in hip pain, and crutches were prescribed. On the following day he slipped
and fell down a flight of stairs. Pain was excruciating, and he was unable to move the
right hip.

A physical examination showed a well developed and well nourished white male. The
general examination was essentially normal. An orthopedic examination revealed marked
muscle spasm in the region of the right hip. Active motion in an\' degree was restricted
because of pain. The right leg was held in flexion and external rotation and could be pas-
sively rotated internally to within ten degrees of neutral. Thus internal rotation was
minus ten degrees. Shortening of the right leg by two centimeters was observed on men-
suration of both lower extremities. Pd\ other joints were freely movable. Laboratory
examinations were as follows: blood count within normal limits; urine normal; serology
negative; sedimentation rate 37 millimeters in one hour. Roentgenographic examination
demonstrated the slipping of the capital epiphysis of the right femur (Figure 4) .

As a preliminary procedure to overcome the muscle spasm, and in anticipation of hip
surger\-, a Kirschner wire was drilled through the tibia just beneath the tibial tubercle.
Five pounds of traction was used with a gradual improvement in the contracture of the hip.
On Ma\- 18, 1948 under general anesthesia an osteotomy of the neck of the right femur was
performed. A curved chisel was used and followed the line of the epiphj'seal plate. This
permitted rotation of the head back to is normal position. The operative findings were
marked callus formation at the junction of the head with the neck. The head was fixed
firmly to the neck and was separated onl\' after the use of a sharp curved osteotome and a
moderate amount of force. Internal fixation of the head was secured using a Smith-Peter-
son nail (Figure 5).

Postoperative!}' the right lower extremit}- was kept in light balanced traction for four
weeks so that active motion could be carried on during this time. Physiotherap)' and
active exercise without weight bearing has produced in a period of fourteen weeks since
surger\', a full range of motion in the right hip. The onh' difference clinically between
the right and left hips is a five degree loss in internal rotation of the right hip. Roent-
genography after fourteen weeks following removal of the Smith-Peterson nail shows heal-
ing of the osteotomy and no evidence of aseptic necrosis (Figure 6A and B).

COMMENT

One case of slipped capital femoral epiphysis has been presented in which
osteotomy of the neck of the femur was performed in order to restore the
head to its proper position. This form of therapy is advocated only in those
cases of severe slipping in order to return the hip joint to its normal func-
tional position. The complication of aseptic necrosis of the head has not
been observed. However, the patient should be followed closely, as this
may occur at any time up to two years post operatively. Two additional
cases have been operated on recently but sufficient time has not elapsed for
the full evaluation of their final result.

MARKEEIM— FEMORAL NECK OSTEOTOMY 143

BIBLIOGRAPHY

1. Badgley, C. E., Isaacson, A. S., Wolgamot, J. C, and Miller, J. W.: Operative

Therapy For Slipped Upper Ferooral Epiphysis. J. Bone & Joint Surg. 30A: 19
(Jan.) 1948.

2. Green, W. T.: Shpping of the Upper Femoral Epiphysis. Diagnostic and Thera-

peutic Considerations. Arch. Surg., 50: 19, 1945.

3. Martin, P. H. : Slipped Epiphysis in the Adolescent Hip. J. Bone & Joint Surgery

30A: 9 (Jan.) 1948.

4. Mearns, R. B.: Early Diagnosis of Slipping of the Upper Femoral Epiphysis. BuU.

School Med. Univ. Maryland, 33: 26, 1948.

CRYPTORCHIDISM

A Preliminary Report on Treatment by Ligation of the
Inferior Epigastric Vessels*!

ERWIN R. JENNINGS, M.D., and CYRUS F. HORINE, M.D.

BALTIMORE, JIARYLAND

Many surgical procedures have been advocated for the treatment of
cryptorchidism. However, most of these operations are based on stripping
the cord of all structures except the essential vessels and vas deferens.
These latter structures are then stretched by some type of anchoring pro-
cedure. This type of repair is obviously not ideal as regards the physio-
logic function of the testicle. A method of treatment is presented which
obviates some of the undesirable aspects of the usual types of repair.

An anatomic knowledge of the vital structures is necessary for a proper
interpretation of the method. The contents of the spermatic cord are: the
internal spermatic artery, the external spermatic artery, the artery to the
ductus deferens, the spermatic veins, lymphatics, nerves, the ductus de-
ferens, and the coverings of the cord (3). Although an attempt is usually
made to save all essential constituents of the spermatic cord, the only true
vital structures are the ductus deferens, the artery of the ductus deferens and
a branch of the spermatic vein. The artery of the ductus deferens anasta-
moses freely with the internal spermatic artery. High Hgation of the latter
does not always cause circulatory embarrassment of the testicle. This fact
as shown by Callender (2) is borne out by the operation for varicocele in
which the internal spermatic artery is frequently sacrificed. Thus, the
ductus deferens not only is a landmark to the nerve supply of the testicle
but also under certain conditions to its blood supply. Because of the
multiple anastomoses of the branches of the internal spermatic vein and free
communication to the vein of the opposite side, Hgation of this structure
presents no problem. Therefore, to aU practical purposes, a surgical pro-
cedure which lengthens the ductus deferens without undue tension is ideal
for the treatment of cryptorchidism. The technique presented is a one
stage operation based on the lengthening and transposition of the spermatic
cord without tension, and without harm to the vital structures.

The means by which the vital structures of the spermatic cord are length-
ened is by the hgation and division of the inferior epigastric vessels and
obhteration of the floor of the inguinal canal. This results in lengthening of
the cord by omitting the angle which the ductus deferens assumes when
coursing around the inferior epigastric vessels.

* From the Department of Urology, School of Medicine, University of Maryland,
t Received for publication September 27, 1948.

144

JENNINGS AND HORINE— CRYPTORCHIDISM 145

Three cases have been treated in this manner. None of these cases has
required Ugation of the internal spermatic vessels. None of the testicles
was anchored under tension. One case was successful after a modified
Torek procedure had failed. All 3 cases have obtained good results. They
have been observed for ten, six, and three months respectively.

CASE REPORTS

Case No. 1: D. W. ^4204, a sixteen year old white male was admitted to the University
Hospital on July 6, 1947 because of an undescended left testicle. The patient's only sub-
jective complaint was aching of the testicle after extreme exercise. An examination re-
vealed a well developed white male who was normal in every respect except for an unde-
scended testicle on the left side. That testicle was palpable as a non-tender, easily com-
pressible mass at the lowermost portion of the left inguinal region. The testicle was not
movable. A modified Torek repair was done by suturing the gubemaculum to the left
thigh with ^ 2 chromic catgut. Sutures on the left thigh were removed on the twelfth
postoperative day. The patient was essentially normal until approximately three weeks
postoperativly, when he developed a slow rising of the left testicle. He re-entered the
hospital for treatment.

The second admission was on September 11, 1947. An examination revealed a well
healed left inguinal scar. A mass in the left external inguinal ring was identified as the
left testicle. The patient was prepared for an operation. At the operation a left inguinal
incision was made. The left testicle and cord were freed by sharp and blunt dissection.
The left testicle was found to be small and atrophic. The only identifiable structure of the
cord was the vas deferens. The floor of the inguinal canal was incised and the inferior
epigastric vessels identified. These were doubly ligated with Pagenstacker linen and
divided. The cord was then transposed down over the symphysis pubis, and the testicle
was easily placed into the scrotum. A Ferguson repair was then done, the vas deferens
being tacked to the external inguinal ring. The patient withstood the procedure well.

Case No. 2: F. S. ^ 10287, a fourteen year old white male was admitted to the Uni-
versity Hospital on February 2, 1948 because of an undescended testicle on the right side.
There had been a previous attempt at repair when the patient was five, but details of the
operation could not be obtained. There had been no tendency toward descent of the
testicle so the patient was admitted for operation.

An examination revealed a normal white male who showed no developmental abnor-
maUties. There was a well healed right inguinal scar. A palpable undescended testicle
(movable approximately 1 cm. in each direction), was found at the midpoint in the right
inguinal canal. There was no tenderness or other abnormahty. The patient was prepared
for an operation.

At the operation a right inguinal incision was made. There was a spUt in the fibers of
the aponeurosis of the external obUque muscle presenting the undescended testicle at the
midpoint of the canal. The testicle was bound down by fibrous tissue. The testicle and
cord were freed by sharp and blunt dissection up to the internal inguinal ring. The trans-
versalis fascia was incised from the internal inguinal ring to the symphysis pubic, thus ob-
literating the floor of the inguinal canal. The inferior epigastric vessels were then identified
just above the inguinal ligament. These vessels were hgated and divided, and the prox-
mal end transfixed to the surrounding fascia. The cord was dissected free from the pelvic
portion of the parietal peritoneum and brought down over the symphysis pubis. This
gave added length to the cord. The length was found to be adequate so the testicle was
pushed into the scrotum. The cord was transfixed to the transversahs fascia, and a Fer-
guson repair was done. The patient withstood the procedure well.

146 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Case No. 3: D. O. (#12720), a sixteen year old white male was admitted to the Uni-
versity Hospital on April 5, 1948 because of an undescended testicle on the left side and a
hernia on the right. The testicle had never given him any pain or discomfort. There
was no tendency toward descent. An examination on admission revealed a palpable
testicle in the left inguinal canal at about its mid-portion. The testicle was not movable.
An examination of the right side showed an indirect hernia. The patient was prepared
for an operation.

At the operation a left inguinal incision was made. The aponeurosis of the external
obMque muscle was divided along the course of its fibers. A small testicle was seen to be
rather adherent in the midportion of the left inguinal canal. In the liberation of the
testicle, the artery to the vas deferens was inadvertently severed and consequently ligated.
A pouch was made in the scrotum on the left. The transversalis fascia in the floor of the
inguinal canal was incised from the internal ring to the symphysis pubis. The inferior
epigastric vessels were then exposed, doubly ligated with champion silk, and transsected.
The artery and vein were tied separately. The vas deferens was found to be of adequate
length after obliteration of the angle at the internal ring, but the internal spermatic vessels
were found to be congenitally short. These vessels were freed retro-peritoneally giving
them added length so that the testicle could be put in the upper portion of the scrotum.
The internal spermatic vessels could not be divided because the artery to the vas deferens
had been severed earlier. The gubemaculum, which was long, was then sutured to the
base of the scrotum. The testicle was found to rest approximately three quarters of the
way from the bottom of the scrotum. The cord was transfixed to the transversalis fascia
near the symphysis pubis. A Ferguson repair was done. The patient withstood the
operation well.

This method for the treatment of ctyptorchidism is not entirely new.
Kiefer (4) mentions the possibihty of ligation of the inferior epigastric vessels
for treatment of cryptorchidism where there is a congenitally short ductus
deferens. However, a review of the recent literature reveals no series in
which this procedure is used.

Bevan (1) has ligated the internal spermatic vessels when they were con-
genitally short in order to repair cryptorchidism. The precaution to observe
is the identification of the artery to the ductus deferens before ligating the
internal spermatic vessels.

The use of this procedure in the treatment of cryptorchidism can be
coupled with other standard methods of treatment. Ligation of the inferior
epigastric vessels and transplantation of the cord might prove to be of value
in obliterating a defect in excessively large or recurrent hernias (5),

SUMMARY

In the treatment of cryptorchidism ligation of the inferior epigastric ves-
sels with obhteration of the floor of the inguinal canal is an effective means of
lengthening the cord and transplanting the testicle into the scrotum.

The internal spermatic vessels may be ligated if the artery to the ductus
deferens is left intact; but the vessels should be preserved if at all possible.

Three cases are presented in which the inferior epigastric vessels were
divided and cord lengthened with good results.

JENNINGS AND EORINE— CRYPTORCHIDISM 147

BIBLIOGRAPHY

1. Bevan, a. D.: Operation for Undescended Testis, Further Study and Report, Ann.

Surg. 90: 847-863 (Nov.) 1929.

2. Callender, Latimer C: Surgical Anatomy, ed. 2, Philadelphia and London, W. B.

Saunders Company, 1939.

3. Gray, Henry : Anatomy of the Human Body, Revised and Re-edited by Lewis, Warren

H.; ed. 21, Philadelphia and New York, p. 1249. Lea & Febiger.

4. KiEEER, Joseph H.: Cryptorchidism: Problems in Surgical Treatment, Illinois M. J.

91: 297 (June) 1947.

5. Hernioplasty with this modification to be pubhshed at a later date.

HISTOPLASMIN SENSITIVITY AMONG 143 PATIENTS AT

THE UNIVERSITY OF MARYLAND CHILDREN'S

DISPENSARY* t

LOUIS V. BLUM, M.D. and RUTH W. BALDWIN, M.D.

BALTIMORE, MARYLAND

In recent years there has been a marked interest shown in puhnonary cal-
cifications associated with a negative tuberculin test. When this test was
used as the chief method of mass tuberculosis survey, pubnonary calcifica-
tions associated with a positive tuberculin were regarded as the result of
infection with the tuberculosis bacillus. However, with the advent of mass
roentgenography for tuberculosis survey, it was soon discovered that there
was a marked disproportion between puhnonary calcifications and positive
tubercuhn tests, and that many of the calcifications were associated with a
negative test. This disproportion was particularly marked in the surveys
conducted in some of the East Central States, where as high as 70 per cent
of the cases of pulmonary calcifications were found to be tuberculin negative.
Furthermore, search for an explanation of the calcifications led to the dis-
covery that most of these tubercuhn negative cases reacted in a positive
manner to histoplasmin. These findings led to intensive investigations
directed towards the study of the significance of the positive histoplasmin
in cases of pulmonary calcifications with a negative tuberculin. These
studies are now in full progress in centers set up for this purpose.

These findings became of practical importance to members of the section
for diseases of the chest of the Pediatric Dispensary at the University Hos-
pital, where puhnonary calcifications constitute a large share of the diag-
nostic problems. Like others, the authors had seen cases of pulmonary
calcifications accompanied by a negative tuberculin. They decided to
discover just how much of a factor histoplasmin sensitivity was in this
locality and whether or not histoplasmosis should be seriously considered in
their practice in the differential diagnosis of pulmonary calcifications.

For this purpose, histoplasmin was obtained from Dr. Michael L. Furcolow
who is one of the group established for the study of histoplasmosis by the
United States Public Health Service at the University of Kansas Medical
Center, Kansas City, Kansas, The test material was used in the 1 : 1000
dilution. The intracutaneous method was employed and interpreted exactly
as in the tuberculin test. The studies were carried out in 1946 and 1947.
All children who appeared for an initial examination at the chest clinic were

* From the Department of Pediatrics, School of Medicine, University of Maryland,
t Received for publication May 13, 1948.

148

BLUM AND BALDWIN— HISTOPLASMIN SENSITIVITY 149

subjected to both a tuberculin and a histoplasmin test and were referred for
a roentgenograph of the chest. Some of the children in this survey were
tested in a similar way in the general pediatric dispensary. No attempt was
made to select patients on any basis, the purpose being simply to test for
histoplasmin sensitivity a sample of the population which visits the Dis-
pensary.

Although the stock material will last for several months under refrigeration,
it was found to lose potency rapidly when diluted, and then is probably not
suitable for use after a month's time even when refrigerated. For this reason
fresh material in the dilution of 1 : 1000 was prepared weekly and kept under
refrigeration when not in use. An injection of 0.1 cc was given, intracu-
taneously, into the anterior aspect of the forearm and a reading was made
forty eight to seventy two hours later. Redness without swelling was con-
sidered negative. An area of swelling 5 mm or more in diameter was con-
sidered necessary for the test to be read as positive. Edema of 5 to 10 mm
in diameter was read l-f ; 10 to 20 mm was read 2+ ; above 20 mm, 3+ ; and
if ulceration were noted, it was read 4-f-. This, as has been stated, is also
the accepted method for the interpretation of the tuberculin test.

The true relationship between a positive histoplasmin and the cause of
pulmonary calcifications has not, so far, been definitely established. In
other words, positive proof has not yet been found that pulmonary calcifi-
cations are necessarily the result of histoplasma infection simply because
the patient is histoplasmin positive and is negative to all other allergens
known to be associated with calcifications. All evidence does seem to point
to this relationship being real, but until enough studies have been carried out
to put the histoplasmin test on firm scientific ground, this point will have to
be considered as not definitely settled. One of the dif&culties in correlation
of the test with clinical and roentgenographic findings lies in the fact that
there seems to exist a cross-immunity among the various allergens which are
known to be associated with pulmonary calcifications. Among these are
Blastomycosis, Coccidiodomycosis and infections with Haplosporangium.
It is known that patients infected with one of these will show sensitivity to
one or all of the corresponding allergens. On the other hand, no cross-
immunity is known between Tuberculosis and any of the above infections.
The recent development of a complement fixation test for Histoplasmosis
may help to solve the problem of specificity of the histoplasmin test.

The results of the present survey are as follows:

One hundred and fifty-eight children were tested. Of these, 15 did not
return for reading of the histoplasmin test, and 4 of these also did not return
for the reading of the tuberculin test. Of the 158, 77 were females, 81 males;

13 were white, 145 negro. The patients ranged between the ages of 1 and

14 years.

150

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Ninety seven of the patients were born in Baltimore, 1 in North Carolina
and 1 in Pennsylvania. The birthplace of the remainder was not known.

Of the 20 patients who had a positive histoplasmin test, 1 was born in
Pennsylvania and 10 in Baltimore; the birthplace of the remainder was ndt
known. The patient with a doubtful histoplasmin test was born in
Baltimore.

Of the 143 cases that returned for reading, there were 20 (13.9 per cent)
histoplasmin positive and 123 (86.1 per cent) histoplasmin negative. There
was 1 doubtful histoplasmin test which is included in the group found tuber-
culin positive and histoplasmin negative. Among the positives none could
be interpreted as being 3+ or 4+ and only several were 2+ . The remainder
were read as 1+ or weakly positive.

Seventeen patients (11.9 per cent) were positive to both histoplasmin and
tuberculin. Of these, 7 showed pulmonary calcifications. Only 3 patients
were histoplasmin positive and tuberculin negative, and none of these
showed any evidence of calcification on a roentgenograph.

Out of 77 cases that were tuberculin positive and histoplasmin negative,
50 showed calcification on the roentgenographs.

There were 5 cases that were histoplasmin and tuberculin negative. All
of these were thought to have pulmonary calcifications as revealed by
roentgenographs, but this was not absolutely certain.

The above data are summarized in the accompanying table:

T+H+'

T-H-

T-H+

T+H-

No of cases

Percent of cases

No. of cases showing calcification on roent-
genograph

17
11.9%

32.2%

5(?)

2.1%

77
53.8%

T+ tuberculin positive
T— tuberculin negative

H+ histoplasmin positive
H— histoplasmin negative

From the above findings, it seems reasonable to conclude that:

1. The incidence of histoplasmin sensitivity among the population that
visits this clinic is low, especially when the figure of 13 per cent is compared
with that of 70 per cent given for those areas in the East Central United
States where histoplasmosis is thought to be endemic.

2. No cases of pulmonary calcification were found which could be sus-
pected of being caused by histoplasmosis.

3. Histoplasmosis probably plays an insignificant part in the differential
diagnosis of pulmonary calcification among the pediatric patients at this
clinic.

BLUM AND BALDWIN— HISTOLPLASMIN SENSITIVITY 151

4. The vast majority of cases of pulmonary calcification in the authors'
pediatric clientele is the result of tuberculosis.

Ackfiffwlegments: The authors wish to express their gratitude to:

Dr. A. Finkelstein, Director of the Clinic, for his help and encouragement
in carrying out this study.

Miss Bertha Lee of the Social Service Department, without whose coopera-
tion this study could hardly have been made.

Dr. Milton S. Sachs, reviewed the material and made valuable suggestions
for its arrangment.

BIBLIOGRAPHY

1. Bunnell, I. L. and Furcolow, M. L.: A Report of Ten Proven Cases of Histoplas-

mosis, Public Health Rep. 63: 299-315 (May) 1948.

2. Christie, Amos and Peterson, J. C: Pulmonary Calcifications in Negative Reactors

to Tuberculin, Am. J. Pub. Health 35: 1131-1147, 1945.

3. Furcolow, M. L., High, R. H., and Allen, M. F.: Some Epidemicological Aspects

of Sensitivity to Histoplasmin and TubercuUn, Public Health Rep. 61: 1132-1144
(Aug.) 1946.

4. Furcolow, M. L., Mantz, H. L., and Lewis, Ira: The Roentgenographic Appearance

of Persistent Pulmonary Infiltrates Associated with Sensitivity to Histoplasmin,
Public Health Rep. 62: 1711-1717 (Dec.) 1947.

5. KusMA, J. F.: Histoplasmin-pathology and Clinical Finding, Dis. of Chest 13:

338-344 (July-Aug.) 1948.

6. Palmer, C. E.: Non-tuberculous Pulmonary Calcifications and Sensitivity to Histo-

plasmin, PubUc Health Rep. 60: 513-520 (May) 1945.

OBSTETRIC CASE REPORT*t

A twenty-four year old patient reported to a physician early in her pregnancy. The
family and past histories were irrelevant except for her only previous pregnancy and labor,
which had been terminated by low cervical section at term because of placenta previa.
The post-operative course was normal, and both mother and infant did very well.

An examination early in this pregnancy was completely negative; the pelvis was normal
and the pregnancy proceeded without incident. The problem in this case is the type of
delivery. Shall a repeat section be done or shall the patient be allowed to go into labor
and the baby be dehvered from below? What further information should be obtained to
help in reaching a decision?

Question: How should patient be delivered?

DISCUSSION

In the early days of cesarean section, where infection was ahnost the rule,
the danger of uterine rupture in a subsequent pregnancy was so great that
the dictum arose, "once a cesarean, always a cesarean." With improve-
ments in operative technique, the incidence of infection decreased markedly,
and with it the danger of rupture. The practice of doing repeat sections
upon the sole indication of a previous section was largely abandoned. Over
a period of years a large amount of data upon the subject was accumulated
and studied. It would appear that in from 1 to 2 per cent of all cesarean
sections, rupture of the uterus wiU occur in a subsequent pregnancy or labor.
Several factors would seem to increase the possibihty of this accident:

1. The type of section. When the incision was in the body of the uterus
(classical) the incidence of rupture is many times greater.

2. The postoperative course. Infection delays or prevents healing.

3. The possibility of prolonged or difficult labor, which would throw a
greater strain upon the scar. (This is questionable. A well healed incision
should be as strong as any other part of the uterus).

4. The location of the placenta in relation to the scar. Placental implan-
tation at the site of the previous incision appears definitely to increase the
danger of ruptmre. Today, placental visualization by means of roentgeno-
graphy is weU advanced and successful in a large majority of cases when done
near term.

In the event of rupture of the incision, the fetus is frequently extruded into
the peritoneal cavity and dies. There is usually marked blood loss and
shock, and the maternal mortality even under the most favorable conditions
is about 25 to 35 per cent.

As a result of the above figures, there is a tendency on the part of many
authorities to return to the original dictum and to do repeat sections. In
this way they eliminate rupture during labor but not during pregnancy.

* From the Department of Obstetrics, School of Medicine, University of Maryland.
t Received for publication November 10, 1948.

152

OBSTETRIC CASE REPORT 153

In the case under consideration, placental visualization by means of
roentgenography should be done and if the placenta is found to be low and
under the site of the incision, a repeat section should be done. If it is not,
the risk of dehvery from below is not much greater than the overall risk of
abdominal delivery itself and can probably be safely undertaken. Dehvery
must be in a well equipped hospital and must be supervised by some one
competent to meet any emergency.

ACTUAL TREATMENT

The actual treatment was as outlined above. Labor was easy and un-
complicated. There was an uneventful recovery.

PROCEEDINGS

of the
University of Maryland Biological Society

Officers of the Society

Vernon E. Krahl, President Donald E. Shay, Treasurer

School of Medicine School of Pharmacy

Baltimore, Md. Baltimore, Md.

R. Dale Smith, Secretary Ronald Bamford, Secretarial Representative

School of Medicine Department of Botany

Baltimore, Md. College Park, Md.

Councilors

F. H. J. Figge

W. E. Hahn

M. A. Andersch

G. P. Hager

The first program meeting of the University of Maryland Biological So-
ciety for the fall term was held on October 20, 1948. Preceding the pro-
gram, members of the Society cast their ballots in the election of officers for
the coming year. The names of the new officers appear above.

The speaker at this meeting was Dr. Amedeo S. Marrazzi, Chief, Toxi-
cology Section, Army Chemical Center, Maryland. Dr. Marrazzi presented
a paper entitled: Electrical Sttidies on the Physiology and Pharmacology of
the Synapse. An abstract of this paper follows:

ELECTRICAL STUDIES ON THE PHYSIOLOGY AND PHARMACOLOGY OF

THE SYNAPSE

Amedeo S. Marrazzi, M.D.*

A survey of the problems of intra- and intercellular communication and the evolution
from the unicellular organism to man of mechanisms of conduction and transmission point to
the joint, complementary operation of a rapid and more discrete electrical and a slower and
less discrete chemical mediation. This is well exemplified in the autonomic nervous system
where adrenaline and acetylcholine are known to be the agents responsible for transmission
at neuro-effector junctions. In the sympathetic system chemical mediation on a gross
scale is effected by the release of secretion from the adrenal medulla. Acetylcholine is also
known to be instrumental in neuro-neuronal or synaptic transmission in autonomic ganglia.

Conduction and transmission in the nervous system can be readily studied by applying
controlled pre-synaptic electrical stimuli and recording the postsynaptic action potentials
as an accurately localizing and quantitative index of synaptic activity. Sympathetic
ganglia lend themselves to this purpose because of their relative simpUcity and accessi-
bility. The preganglionic nerves are sectioned, thereby eliminating complicating reflexes,

* Toxicology Section, Medical Division, Army Chemical Center, Maryland.

154

UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY 155

and the ganglionic circulation is left intact so that drugs may reach the synapse by the
normal channels. Conduction can be recorded simultaneously with transmission in
ganglia, such as the inferior mesenteric, where some presynaptic fibers run right through
the ganglion to synapse at some point distal to the recording electrodes placed on the post-
ganglionic nerves.

By these methods it has been possible to show that: —

1. Adrenaline in physiologic concentrations, either intravenously injected or liberated
by stimulating the splanchnic nerve, is capable of producing synaptic inhibition in all types
of sympathetic ganglia without influencing simultaneously recorded conduction in nerve
fibers with the same blood supply. This may be the basis for a self-Hmiting mechanism in
sympathetic homeostatic adjustment which could automatically restrain the adenergic
nervous system from excessive activity that could be detrimental. This primary inhibi-
tion is distinguishable from "postinhibitory" and ischemic facilitation.

2. All sympathomimetic amines studied so far, as e.g., ephedrine and noradrenahne,
exhibit this action in varying degrees. This includes those amines, like noradrenaline,
that have been suggested as being sympathin E. This fact would necessitate a change in
the definition of sympathin E.

3. A correlation between chemical structure of sympathomimetic amines and the ratio
of inhibitory to excitatory activity is possible.

4. As might be expected from the cholinergic nature of excitation in sympathetic gan-
gha, atropine blocks and pilocarpine augments transmission. The action of atropine, as in
the case of adrenaline, sharply differentiates between conduction and transmission in that
doses markedly altering the latter have no effect on the former. This removes the cri-
terion for the artificial distinction made between the so-called muscarinic and nicotinic
action of acetylcholine and suggests that a terminology should be used that does not imply
a basic difference in mechanism among the various actions of acetylcholine.

5. The anti-choHnesterases, diisopropylfluorophosphate and physostigmine exert simi-
lar differential effects on synaptic transmission resulting in enhancement in small doses
and depression in large ("intra-^arterial") doses, without any effect on simultaneously re-
corded conduction. In the Hght of this last, the reported effect of diisopropylfluorophos-
phate on nerves in vitro must be considered to be of only toxicologic interest.

By applying similar techniques to the central nervous system and using the Horsley-
Clarke stereotaxic instrument to place the stimulating and recording electrodes accurately,
it has been shown that adrenahne, ephedrine, and amphetamine produce synaptic inhibi-
tion in the systems so far studied, viz., the visual and auditory. Thus, "blindness with
rage" may have a real physiologic counterpart.

By recording the action potentials accompanying the spontaneous train of impulses
coursing out over the preganglionic nerves, it has been possible to show that the anomalous
central or hypothalamic action attributed to chloroform and cyclopropane, and thought to
be responsible for the cardiac irregularities they produce, is in fact of peripheral origin
since there is no change in the recorded sympathetic outflow. Such changes can be easily
demonstrated by other means such as by asphyxiating the animal.

The question of release phenomena consequent to central synaptic inhibition account-
ing for the apparent "mixed" stimulant and depressant action of drugs Hke ephedrine and
amphetamine and certain anesthetics was discussed.

A program of further work to examine synaptic transmission systematically throughout
the nervous system, utilizing techniques of controlled stimulation of homogenous groups
of synapses and recording the action potentials in postsynaptic neurons was outlined.

ALUMNI ASSOCIATION SECTION

James S. Billingslea, M.D.
Thurston R. Adams, M.D., Secretary
MiNETTE E. Scott, Executive Secretary
Board of Directors

OFFICERS*

Albert E. Goldstein, M.D., President
Vice-Presidents
E. Paul Knotts, M.D. Charles C. Zimmerman

Simon Bragek, M.D., Assistant Secretary
Charles Reid Edwards, M.D., Treasurer

Wetheebee Fort, M.D.,

Chairman
Albert E. Goldstein, M.D.
Charles Reid Edwards, M.D.
Thurston R. Adams, M.D.
Simon Bragee, M.D.
Louis A. M. Keause, M.D.
Emil Novak, M.D.
William H. Triplett, M.D,
Austin Wood, M.D.

Louis H. Douglass, M.D.

Hospital Council
Alfred T. Gundey, M.D.
George F. Sargent, M.D.
Nominating Committee

Frank Geraghty, M.D.

Chairman

W. Raymond McKenzie, M.D.
Frank Ogden, M.D.
Robert F. Healy, M.D.
Ernest I. Cornbrooks, M.D.

Alumni Council

Library Committee

Milton S. Sacks, M.D.

Representatives to General
Alumni Board

John A. Wagnee, M.D.
Thurston R. Adams, M.D.
William H. Triplett, M.D.

Editors
John A. Wagnee, M.D.
C. Gardner Warner, M.D,

Lewis P. Gundry, M.D.

• The names listed above are officers for the term beginning July 1, 1948 and ending June 30, 1949.

NEWS ITEMS

Dr. Thomas S. Saunders (University of Maryland 1932) has recently been
promoted from Assistant Clinical Professor to Associate Clinical Professoi
in Dermatology and Syphilology at the University of Oregon Medical School
in Portland, Oregon.

Dr. Mabel I. Silver (University of Maryland 1929) is spending a year in
the United States, At the end of this time she will return to her work as a
medical missionary in Rotifunk, Sierra Leone, West Africa.

Dr. William H. Chapman (University of Maryland 1929) has been em-
ployed to serve with the Division of Maternal and Child Health of the State
Board of Health. His work will be principally educational, with emphasis
on child growth and better family life. He will be available as speaker to
local medical groups.

156

OBITUARIES

Baird, David Edwin, Port Oreford, Ore.; B.M.C., class of 1906; aged

71; died, March 30, 1948, of coronary thrombosis, diabetes melli-

tus, and acute lymphatic leukemia.
Barnes, Louis Dwight, Lanesboro, Mass.; P & S, class of 1913; aged

58; served during World Wars I and II; died, January 22, 1945,

on board a Japanese prisoner of war transport at sea, of exposure

and starvation.
Bell, Henry R., Oakland, Calif.; class of 1879; aged 94; died, June 30,

1948, of acute dilatation of the heart.
Bosworth, John L., Elkins, W. Va.; P & S, class of 1889; aged 91;

died. May 14, 1948, of senility.
Bradley, Theron Robert, South Norwalk, Conn.; class of 1914; aged

69; died, July 7, 1948, of coronary thrombosis.
Campbell, Robert E. L., Baltimore, Md.; class of 1904; aged 73; died,

June 30, 1948, of bronchopneumonia and carcinoma of the

stomach.
Dow, Henry Baker, West Springfield, Mass.; B.M.C., class of 1911

aged 71; died, June 7, 1948, of hypertensive cardiovascular dis

ease and hemiplegia.
Dunphy, Henry A., Palmer, Mass.; B.M.C., class of 1908; aged 66

died, June 11, 1948, of cerebral embolism.
Eakin, Byron Wallace, Blackburg, Va.; class of 1903; aged 73; died

May 28, 1948, of a malignant condition of the liver.
Elder, Willis E., Columbus, O.; P & S, class of 1895; aged 81; died

June 14, 1948, of chronic myocarditis.
Fadeley, George B., Arlington, Va.; class of 1889; aged 86; died

August 18, 1948.
Foley, Joseph Daniel, Springfield, Mass.; class of 1916; aged 55

served during World War I; died, August 13, 1948, of cerebral

hemorrhage.
Garland, George Franklin, Winthrop, Mass.; B.M.C., class of 1898

aged 81; died, March 28, 1948, of chronic myocarditis.
Herring, William Edwin, Ida, La.; P & S, class of 1891; aged 86; died

April 19, 1948.
Johnson, Clay, Fort Worth, Texas; P & S, class of 1891; aged 81; died

March 7, 1948, of hemiplegia.
Lawson, Aubrey Francis, Weston, W. Va.; P & S, class of 1911; aged

61; died, June 20, 1948, of heart disease.
Leahy, William Joseph, Ansonia, Conn.; P & S, class of 1899; aged 71;

157

158 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

died, May 31, 1948, of cardiac infarct, pulmonary embolus and

arteriosclerosis.
Lee, Robert Richard, Martinsville, Va.; P & S, class of 1893; aged 79;

died, June 6, 1948, of intestinal hemorrhage.
MacLean, Hector John, Boston, Mass.; B.M.C., class of 1908; aged

72; died, June 21, 1948, of heart disease.
McCabe, Vincent Valens, Millbrook, N. Y.; B.M.C., class of 1901;

aged 73; died, May 30, 1948, of subdiaphragmatic abscess and

toxemia.
Morgan, Aston Hugh, Wilkes-Barre, Pa.; P & S, class of 1891; aged

90; died. May 27, 1948, of hypostatic pneumonia and arterio-
sclerosis.
Morrow, Charles W., Fairhope, Ala.; class of 1888; aged 81; died,

March 25, 1948.
Price, Daniel J., Columbus, 0.; B.M.C., class of 1902; aged 70; died,

May 26, 1948, of cerebral hemorrhage.
Rau, Rudolph M., Frederick, Md.; P & S, class of 1893; aged 76; died,

May 26, 1948, of cerebral hemorrhage.
Riely, Compton, Baltimore, Md.; class of 1897; aged 76; died, June

27, 1948, of lobar pneumonia and coronary thrombosis.
Riley, John Lee, Snow HiU, Md.; class of 1905; aged 73; died, July

24, 1948, of carcinoma of the colon.
Sullivan, Daniel E., West Hartford, Conn.; B.M.C., class of 1910

aged 60; died, March 23, 1948, of cerebral hemorrhage.
Von Dreele, John Henry, Baltimore, Md.; class of 1910; aged 63

died, March 2, 1948, of ruptured abdominal aorta.
Williams, Charles Frederick, Columbia, S.C; class of 1899; aged 72

died, June 3, 1948, of coronary occlusion.

BULLETIN

OF THE

SCHOOL of MEDICINE

UNIVERSITY OF MARYLAND

VOLUME 33 No. 5

Publishers:

Faculty of Physic

University of Maryland

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PUBLISHED FIVE TIMES A YEAR
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under the Act of August 24, 1912.

BULLETIN

OF THE

SCHOOL OF MEDICINE

UNIVERSITY OF MARYLAND

Vol. 33 APRIL, 1949 No. 5

THE ELECTROENCEPHALOGRAM AS A DIAGNOSTIC ADJUNCT:
AN ANALYSIS OF FIVE HUNDRED TRACINGS* f

GEORGE W. SMITH, M.D., LEAH MILLER PROUTT, B.S.,
AND ROBERT H. OSTER, Ph.D.

BALTIMORE, MARYLAND

Since 1929 the electroencephalogram has been used in clinical medicine.
The range of normal variation in the electroencephalogram as influenced by
age (1), sleep (5, 9), attention (8), drugs (7), and the effect of blood and
oxygen supply to the brain has been well established. Although the early
work of Hans Berger (2) dealt mainly with psychiatric disorders, it was
soon recognized that the electroencephalogram was of little value in this
field except to rule out organic disorders. The work of Gibbs, Davis and
Lennox (6) revealed that a typical pattern was yielded in "idiopathic"
epilepsy. It is in this field that electroencephalography has enjoyed
its greatest use, as this is the only laboratory procedure which can confirm
clinical epilepsy. It was not until 1933 that the electroencephalogram
was recognized as an aid to diagnosing organic neurologic lesions. In
that year Gibbs first discovered that brain tumors produced abnormal
electric activity in the cerebral cortex. Walter (13) later described the
value of brain waves in diagnosing the various t)rpes of intracranial hem-
orrhages and tumors. Case and Bucy (4) also employed electroenceph-
alographic techniques in localizing brain tumors.

It has long been known that the passage of the nerve impulse causes a
transient change in electric charge on the surface of the nerve. In the brain
there are thousands of such nerve cells interrelated by a network of complex
circuits, many of which involve subcortical projections to the basal ganglia.

* From the Department of Neurosurgery, and the Department of Physiology, Schools
of Medicine and Dentistry, University of Maryland.
t Received for publication February 1, 1949.

159

160 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Each unit is not independent but becomes a part of organized activity of
the whole brain. When left undisturbed, these many neurones tend to
discharge electrically in unison with an organized synchrony. There is
a spontaneous, apparently autonomous, rhythm of these waves continu-
ously going on within the human brain whether awake or asleep. Electric
activity of the brain, then, appears on the electroencephalogram as a series
of simple rhythmic waves with only gross dominant patterns of cortical
activity.

The electric potentials generated are minute, and in order to obtain a
record of these potentials, they must be amplified approximately ten mil-
lion times.

It is now well recognized that abnormal brain waves are associated with
metabolic disorders of the brain cells, so that conditions such as anoxia,
increased intracranial pressure, cortical degeneration or destruction, and
cortical irritation will disturb the physio-chemical system of the brain and
will be reflected directly in the electroencephalogram pattern. Thus the
electroencephalogram has offered a new and different approach for study-
ing neurologic disorders in that the recorded brain waves may be inter-
preted as disturbances of physiologic activity. These can be measured
and any alteration in the bio-electric activity of the brain is reflected in
the electroencephalogram as abnormal brain waves. It is thus possible
to study cerebral function from a physiologic standpoint directly instead of
indirectly as evidenced by altered sensory or motor function, altered reflexes
and altered spinal fluid findings.

The establishment of electroencephalography at the University Hospital
was followed by the installation of a Grass six-channel electroencephalo-
graph, first placed in operation during October, 1946.* From 1942 to 1946
tests were carried out in the laboratory of one of the authors (RHO) on
several hundred normal subjects and on patients referred because of neuro-
logic dysfunctions.

Much has been written concerning the electroencephalogram in certain
specific cUnical entities, but there have been few critical analyses of
its scope and general usefulness. The first objective of this review was to
determine the types of cases being referred. The second objective was to
decide in which types of cases the electroencephalogram was of assistance
to the chnician.

The present study is based entirely upon tests performed since 1946.
During this period over one thousand tracings have been recorded. Patients
seen in the electroencephalogram laboratory all presented neurologic
symptoms or signs. In each case the electroencephalographic procedure

* The establishment of this electroencephalographic laboratory was made possible in
the University Hospital by the Hoffberger Neurosurgical Fund.

SMITH, PROUTT AND OSTER—THE ELECTROENCEPHALOGRAM 161

seemed to promise help in the diagnosis or prognosis by following the course
of improvement or deterioration of the patient during his illness. The
usefulness and the reliability of the procedure are still being established,
and it is felt that the time is at hand for a review of this series, attempting
to correlate the electroencephalograph findings in each case with the final
established cHnical diagnosis.

The electroencephalograph is obtained by placing a series of electrodes
on the scalp. These are connected to a series of high-fidelity amplifiers
which magnify the minute bio-electric potentials generated by the ganglion
cells, so as to make it possible for them to be recorded by ink writing pens
on a moving sheet of paper. The development of modern electronic equip-
ment was of necessity a prelude to obtaining satisfactory electroencephalo-
graphic tracings. The electroencephalogram is a highly sensitive instru-
ment, furnishing a reliable record of cortical potentials.

Inasmuch as the electroencephalogram is a measure of the physiologic
activity of the brain and in disease reflects the altered activity, it was
difficult to correlate the findings with the clinico-pathologic diagnoses
which are of necessity based on anatomic deviations; i.e., brain tumor,
massive intracerebral hemorrhage and infarction. It was felt that grouping
of the tracings under rather broad classifications having a conunon patho-
genesis was necessary. These included the following: destructive cerebral
lesions (under which were all classified brain neoplasms, massive intra-
cerebral hemorrhage, thrombosis and encapsulated abscess). Inflam-
matory disorders included all of the meningoencephalitides and spontaneous
subarachnoid hemorrhages. Convulsive disorders included all of the "idio-
pathic" epilepsies, petit mal, grand mal, psychomotor equivalent states,
and a certain group of tracings which were called epileptoid. Degenera-
tive states included the cortical atrophies, small infarcts, arterioscleroses
and encephalopathies. The traumatic group included the craniocerebral
injuries, extradural and subdural ''clots," concussions and contusions,
traumatic subarachnoid hemorrhage and the post-traumatic syndromes.
The metabolic group included the hypoglycemic patients, the drug intoxi-
cations, toxemias of pregnancies and the uremic states. There was a group
of tracings which were called borderline normal because of insufficient evi-
dence to support an abnormal interpretation. If these cases subsequently
revealed a clinical entity, the diagnosis of which correlated with the electro-
encephalographic findings, the tracing was considered to be of diagnostic
assistance in drawing the clinician's attention to such a possibility. The
classification of normal is self-explanatory.

The classifications have as their bases the electroencephalogram pattern
or interpretation. By necessity there were certain overlaps but each case
was placed in only one group so that the overall percentages were unaffected.

162

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

i.e., a patient with hypoglycemia having convulsions was placed in the meta-
bolic disorder classification and was omitted from the convulsive disorder
group.

Many of the cases in the series were verified by surgery or autopsy findings.
Otherwise the correlative clinical diagnoses used were the discharge diagnoses
on all hospitalized patients, and on out-patients these were obtained by con-
tacting the referring physician personally or by letter. Whenever the clini-
cal diagnosis was in doubt, that tracing and case were discarded.

The results and percentages given in Table I are based on the first 500
usable tracings. It will be observed that the 500 tracings represented 446
patients (the result of repeated tracings being performed when for any reason
it was indicated in diagnosis or follow-up.) The per cent of accuracy is

TABLE I

CLASSIFICATION

1. Convulsive disorders

2. Destructive cerebral lesions. . .

3. Traumatic brain disorders. . . .

4. Inflammatory disorders

5. Degenerative brain disorders. .

6. Metabolic disorders

7. Borderline normal

8. Normal

Total

146
74
63
40
43
24
43
67

500

131
64
54
39
38
20
36
64

446

OF AID IN
DIAGNOSIS

105
49
42
33
29
18
28
42

OF NO AID
IN DIAG-
NOSIS

PERCENT OF

CASES IN WHICH

THE EEG WAS

OF AID

80.1
76.5

77.7
84.6
76.3
90.0

77.7
65.6

Mean 78 . 6

based on the number of cases and not the number of tracings. It should
be pointed out that the per cent of accuracy is based entirely upon the clini-
cal diagnosis obtained, as explained above, and accordingly the figures are
no more accurate than are the cUnical diagnoses, excepting those cases
verified at operation or autopsy.

COMMENT

Table I shows the case-tracing breakdown with the computed percentages
of cases in which the electroencephalogram was helpful in establishing the
clinical diagnosis.

The convulsive disorders in this series comprised the most tracings. Eighty
per cent of these assisted the clinician in estabhshing a diagnosis, which agrees
with the findings of other investigators. Failures in this group can be
justified by the fact that frequently a patient with cUnical epilepsy will
show a normal or atypical pattern during the interseizure period (14, 3).
The interseizure pattern of the petit mal cases was the most reliable; Figure

SMITH, PROUTT AND OSTER—TEE ELECTROENCEPHALOGRAM 163

tP-LO

a RP-RO

I.F- LO

RF-ffo

iT/\iWvAAAiAJAJAjW\J\J\J'\AJ\AA/
Ajt/tfWWWVWvAA/WWW

j.r- 1. T, .A

ft P

1 second I I 20;iV

l.a. A pattern within the range of normal variation.

l.b. T3^ical petit mal pattern with 2\-i per second dome and spike sequence.

I.e. Tjqjical pattern in a destructive lesion of the left occipital parietal area proved at

surgery. Note the high voltage 1-2/ sec waves most marked in the left occipital and

parietal leads.

lb shows a typical petit mal interseizure pattern with the classical 2| to 3
per second dome and spike waves.

164 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

The next most common cases referred to the laboratory were those showing
a gross destructive type pattern. Because it is impossible to differentiate
by electroencephalogram the t5rpe of brain destruction, i.e., whether it is
the result of neoplasm, massive hemorrhage, thrombosis or abscess forma-
tion, aU such tracings must be interpreted alike (11). The electroen-
cephalogram findings used correlatively with the clinical history and findings,
however, will enable the interpreter to make a reasonably accurate differen-
tiation and diagnosis. The percentage of cases in which the electroen-
cephalogram was of diagnostic help in this series compares favorably with
other laboratories. Figure Ic shows a pattern which is typical for a de-
structive lesion.

In the traumatic group of cases the electroencephalogram was found to be
particularly helpful in differentiating subdural hematomas from severe con-
tusions and extradural hematomas. Subdural hematomas characteristically
showed decreased amplitude with random slow waves over the hemisphere
underlying the hematoma (15-16). The subsequent clinical course of the
post traumatic cases correlated well with the repeated follow-up electro-
encephalogram findings.

In the cerebral inflammatory disorders a characteristic pattern was ob-
tained (Fig. 2a) and with 84.6 per cent of the patients referred the electroen-
cephalogram was of diagnostic benefit. As these patients showed cHnical
improvement the follow-up electroencephalograms approached normal.

The highest percentage of correlation was in the smallest group, meta-
bolic disorders. Figure 2 b is a representative tracing of this group obtained
from a patient who was admitted in coma without history or focal neuro-
logic signs. The electroencephalogram which was obtained 48 hours prior
to death was interpreted as being compatible with the clinical diagnosis
which was of acute phenobarbital intoxication. This impression was con-
firmed at autopsy by the Kapponyi method.

The electroencephalogram of the borderline group contributed to the
clinical diagnosis in 77.7 per cent cases. This percentage could well be
higher if more time were allowed for progressive development of subsequent
clinical findings in these patients.

An analysis of the per cent accuracy showed the lowest efficiency in
normal tracings. This was not surprising: although the patient had real
organic changes or was clinically ill, occasionally the electroencephalogram
would be normal. According to Williams (14), approximately 12 per cent
normal individuals have abnormal electroencephalograms.

In the cases classified as degenerative brain disorders the electroenceph-
alogram was of diagnostic assistance in 76.3 per cent of the cases. This
group of patients frequently offers considerable diagnostic difficulty, as to
whether the symptoms presented are functional or organic, and the finding

SMITE, PROUTT AND OSTER—TEE ELECT ROENCEPEALOGRAM 165

of abnormal brain potentials assists in establishing the correct etiology.
The majority of the tracings interpreted as suggestive of cortical atrophy
were confirmed by pneumoencephalography.

The overall percentage of 78.6 per cent of cases which contributed to the
clinical impression is based on positive electroencephalogram findings, and

S.^u^'WVVw.^^*^^^

I20ii\

l.di.. Typical pattern in a patient having an acute meningoencephalitis. Note the gen-
eralized poor regulation and moderation with marked slowing of the frequency.
2.b. Pattern in phenobarbital intoxication 48 hours prior to death.

it should be pointed out that frequently the negative interpretation (that
the tracing does not show a definite pattern compatible with a suspected
clinical diagnosis), is helpful.

CONCLUSIONS

This survey confirms the belief that the electroencephalograph is helpful
in making diagnoses on patients demonstrating certain neurologic signs

166 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

and symptoms. These include: (a) those patients who have had any form
of convulsions; (b) the unconscious patients; (c) those showing neurologic
deficits of obviously cerebral origin; (d) those patients who have a history
of trauma with suspected intracranial hemorrhage (particularly when sub-
dural hematoma is suspected); and (e) those patients who have signs of
diffuse encephalitis (to confirm the diagnosis, to rule out abscess formation,
and to follow the progress of the patient.)

Results obtained in this laboratory, and also reported by others, (3, 16),
have shown the electroencephalograph to be of no positive aid in the diag-
nosis of psychiatric disorders except in the extreme anxiety states. (These
showed a minimum of the normal 8-12 per second activity and a predomi-
nantly fast 22 per second low voltage wave pattern.) The electroencephalo-
graph in these patients serves the purpose of ruling out an organic etiology
for their illness.

The electroencephalograph has a place in the diagnostic armamentarium
of the clinician, and because the procedure is painless and without morbidity
it should be used where indicated. It should be emphasized, however,
that the electroencephalograph interpretation, as any other single finding,
should not be used alone in establishing a diagnosis, but should be correlated
with all the other findings and used as an adjunct to the overall study of the
patient.

SUMMARY

1. A brief historical background of the electroencephalograph and its
significance in the study of cerebral function is given.

2. The value of the electroencephalogram lies in its direct measurement
of the physiologic activity of the brain and the deviations from the normal
pattern in the pathologic states.

3. A classification of electroencephalograms based on the pathogenesis is
presented.

4. Five hundred electroencephalograms are analyzed and correlated with
the final clinical diagnosis giving the per cent of cases in which the electro-
encephalogram aided in establishing the final diagnosis.

5. The correlation of the electroencephalogram with the clinical diagnosis
was as follows: (a) an average efi&ciency for the series of 78.6 per cent
agreeing diagnosis; (b) 80.1 per cent in the largest group, convulsive dis-
orders; (c) 65.6 per cent in the normal group; (d) 76.5 per cent in the de-
structive lesions group; (e) 77.7 per cent in the traumatic group; (f) 84.6
per cent in the inflammatory group; (g) 90.0 per cent in the smallest group,
metaboUc disorders; (h) 77.7 per cent in the borderline normal group.

6. The classifications showing a per cent efl&ciency of the electroenceph-
phalogram diagnosis with the least deviation from the mean were, with one

SMITE, PROUTT AND OSTER—THE ELECTROENCEPHALOGRAM 167

exception, those with the highest number of cases. These groups are
consequently, the most significant; (a) convulsive disorders; (b) destructive
lesions; (c) traumatic lesions; (d) degenerative lesions.

7. Of all the traumatic lesions in this series the electroencephalogram
pattern in the subdural hematoma was the most reliable.

8. The clinical syndromes in which the use of the electroencephalogram is
indicated are listed.

9. The importance of correlating the electroencephalogram with the
clinical findings is emphasized.

BIBLIOGRAPHY

1. Berger, H.: Ueber das Elektrenkephalogram des Menschen IV. Mitteilung.

Arch. f. Psychiat. 97: 6-26, 1932.

2. Berger, H. : Ueber das Elektrenkephalogram des Menschen III. Mitteilung. Arch.

f. Psychiat. 94: 16-60, 1931.

3. Brazier, M. A. B., Finesinger, J. E. and Cobb, Stanley: A Contrast Between

the Electroencephalogram of 100 Psychoneurotic Patients and Those of 500 Normal
Adults. Am. J. Psychiat. 101: 443-448, 1944-45.

4. Case, T. J., and Buoy, P. C. : Localization of cerebral Lesions by Electroencepha-

lography. J. Neurophysiol. 1: 245-261, 1938.

5. Davis, H., Davis, P. A., Loomis, A. L., Harvey, E. N. and Hobart, G.: Changes in

Human Brain Potentials during the Onset of Sleep. Science 86: 448-450, 1937.

6. GiBBS, F. A., Davis, H. and Lennox, W. G.: The Electroencephalogram in Epi-

lepsy and in Conditions of Impaired Consciousness. Arch. Neurol. & Psychiat.
34: 1133-1148, 1935.

7. GiBBS, F. A., Williams, D., and Gibbs, E. L.: Modification of the Cortical Fre-

quency Spectrum by Changes in CO2, Blood Sugar and O2. J. Neurophysiol. 3:
49-58, 1940.

8. Jasper, H. H., Cruikshank, R. M., and Howard, H.: Action Currents from the

Occipital Region of the Brain in Man as Affected by Variables of Attention and
External Stimulation: Psychol. Bull. 32: 565, 1935.

9. LooMis, A. L., Harvey, E. N., and Hobart, G.: Potential Rhythms of the Cerebral

Cortex during Sleep. Science 81: 597-598, 1935.

10. MossoviCH, A.: The Electroencephalograph in CUnical Practice. Med. Ann. Dis-

trict of Columbia: 14: No. 10, 452-455, 1945.

11. O'Leary, James: Guide to the Indications for Brain Wave Recording. Dis. Nerv.

System 9: No. 9, 263, 1948.

12. Villa viCENCio, Carlos: The Clinical Value of Electroencephalogram, with Special

Reference to Diagnostic Value. Rev. Med. Chile 73: 424, 1945.

13. Walter, W. G.: The Location of Cerebral Tumors by Electroencephalography,

Lancet 2: 305-308, 1936.

14. Williams, Denis: The Clinical Application of Electroencephalography. British

M. Bull. 3: No. 1-3, 18-22, 1945.

15. CoHN, Robert, Laines, George N. and Mulder, Donald W.: Cerebral Vascular

Lesions. Arch. Neurol. & Psychiat. 60: 165-181, (Aug.) 1948.

16. Cohn, Robert: Subdural Hematoma: An Experimental Study. Arch. Neurol. &

Psychiat. 59: 360-367, (March) 1948.

RETROPERITONEAL LIPOSARCOMA: A CASE REPORT*t
PAUL C. CUNNICK, M.D.

BALTIMORE, MARYLAND

Liposarcoma, known as the malignant tumor of lipoblasts, is classified
as one of the rare tumors of the body, and is rarer stUl when found in the
retroperitoneal area.

Moreland and McNamara found only 9 liposarcomas among 16,000
tumors of all kinds. Stout (5) reported a series of 41 cases of liposarcoma
which had accumulated during the past 37 years at Columbia University.
Only 7, or 16.3 per cent of this group, however, were found in the retro-
peritoneal area.

Altogether, there have been 175 cases of liposarcoma reported in the
literature, and only a small number of these were found in the retroperi-
toneal area. It is for this reason, and because it is the only tumor of its
kind seen at the Baltimore City Hospitals, that the following case is reported.

R. S., a 68 year old white male was admitted to the Baltimore City Hospitals Jxine 25,
1948, complaining of hernia, shortness of breath, edema of the legs of three weeks duration,
and some weight loss of one year's duration. The patient was admitted to surgery to have
the hernia repaired before being accepted in the infirmary.

Physical Examination: The patient was a chronically ill, poorly developed, asthenic
white male in no immediate distress. A few axiUary and inguinal lymph nodes were
palpable. The chest was barrel-shaped and the lungs hyper-resonant with moist rales at
the bases. The heart was slightly enlarged with an irregular rhythm and a soft, apical,
S3'stolic murmur. A mass, 10 by 15 cm. was slightly movable in the right lower quadrant
of the abdomen but was tender and smooth in outline. The Uver and spleen were not
palpable. The patient had no symptoms that could be referred to the abdominal mass.
The prostate was slightty enlarged but was not palpable.

Gastro-intestinal studies showed a normal bowel, although it was displaced by a tumor
mass which seemed to be outside the gut.

Kidney studies showed normal organs, but the ureteral catheter on the right could not
be passed higher than the third lumbar vertebra.

The hemoglobin was 7.6 gm., the white blood count 6,800. A urine examination was
negative.

The impression at this time was of a retroperitoneal tumor.

On August 4, 1948 the patient was admitted to surgerj^ for an exploratory laparotomy.
The abdomen was entered through a right lower rectus incision exposing a large tumor
retroperitoneally which displaced the cecum anteriorly and superiorly. The mass ex-
tended past the midline and as high as the lower border of the kidney and down to the brim
of the pelvis. It was about 10 cm. thick, grayish in color and almost jelly-like in consist-
ency. It was adherent to the surrounding tissues, but could be dissected free without
too much difficulty, except around the right iliac vessels. It had no definite capsule.

* From the Department of Surgery, Baltimore City Hospitals, Baltimore, Maryland.
t Received for publication December 28, 1948.

168

CUNNICK—RETROPERITONEA L LIPOSA RCOMA

169

iffi

ir^l

9 10 U Vi. f.5

Fig. 1. Gross specimen of a liposarcoma after its removal from the retroperitoneal area.

Both of the kidnej's felt normal. There were no palpable masses in the liver. The pa-
tient was returned to the ward in good condition after removal of the tumor.*

Pathology Report:

Gross description: The tumor weighed 1440 grams and consisted of an irregular mass of
tissue, soft and flabby in consistency, having firm, nodular areas scattered throughout,
measuring 1 to 5 cms. in diameter. On section, the specimen was found to consist of fatty
tissue, in which were embedded fibrous nodules of a yellowish color. These nodules
blended into the surrounding tissue. There were no areas of necrosis.

Microscopic description: Five sections taken from various areas of the mass showed
tumor cells which varied considerably in size and shape, from small, oval or spindle
shaped cells to large single or multiloculated giant forms. In some areas, manj^ of the
smaller cells closely resembled fibroblasts in size and shape. The cj'toplasm of the large
cells was finely vacuolated with lipoid material. The cytoplasm of the giant cells showed
five processes radiating out into the surrounding stroma. The nuclei were vacuolar with
prominent nucleoli. Numerous mitotic figures were present. In some areas the stroma
was infiltrated with lymphocytes, plasma cells, and occasional polymorphonuclear cells.
Large areas of tumor necrosis were present.

Final Diagnosis: Liposarcoma.

The patient had a relativelj- uncomplicated recovery, hut on August 28, 1948, he suf-
fered a cerebral vascular accident and expired approximately 3 hours later.

* This case was operated on Ijy Dr. Rush E. Netterville of Baltimore City Hospitals,
on the service of Dr. James C. Owings of Johns Hopkins Hospital, Baltimore, Marjdand.

170 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

*--■ *•■--* '^ ', ^ N ' *"•;... >

«?

*> i^n^ji, ^

^iA\'- ^V.V- ■'^■^^J v,S*

Fig. 2. Photomicrograph showing the lipoblasts with a central nucleus and a foamy,

abundant lipoid containing cytoplasm.
Fig. 3. Photomicrograph showing the nucleus compressed to a crescentic shape by the

cytoplasmic fat.

SUMMARY

The above case report is presented because of its rarity, rather than aca-
demic interest. It is the first case of its kind seen at the Baltimore City
Hospitals, and one of the few liposarcomas found in the retroperitoneal area.

CUNNICK— RETROPERITONEAL LIPOSARCOMA 171

BIBLIOGRAPHY

1. Cattell, R. B. and Warren, K. W.: Retroperitoneal Lipoma, S. Clin. North America

27: 659-665 (June) 1947.

2. EwiNG, James: Neoplastic Diseases, 4th Ed., Philadelphia and London, W. B. Saun-

ders Company, 1940.

3. Frank, Robert T.: Primary Retroperitoneal Tumors. Surgery 4: 562-586 (Oct.)

1938.

4. Lahn, Louis: An Unusual Case of Retroperitoneal Tumor. J. Internal. Coll. Sur-

geons 6: 461-468 (Sept., Oct.) 1943.

5. Stout, A. P.: Liposarcoma, The MaKgnant Tumor of Lipoblasts, Ann. Surg. 119:

86-107, 1944.

PRESERVATION OF FERTILITY IN CALCAREOUS
TUBERCULOUS SEMINAL VESICULITIS*!

W. HOUSTON TOULSON, M.D.

BALTmORE, MARYLAND

This is a report of three cases of calcification of the seminal vesicles
associated with tuberculosis of the genital tract with the preservation of
fertUity.

Case 1: H. F. a married white male farmer, age 39, was admitted to the University
Hospital February 6, 1935 with the diagnosis of tuberculosis of the right kidney, right
epididymitis, prostatitis, and calcification of the seminal vesicles. The latter was di-
agnosed by roentgenography and palpation. On February 8, 1935 a right nephrectomy
was done. Subsequent to his discharge from the hospital, the patient took sanitorium
treatment for about one year because of an activation of fibroid tuberculosis infiltrating
both apices of the lungs. The disease became arrested, and he returned home. About a
year and a hah after the operation, the genital tuberculosis had quieted down so that the
patient was symptomless. The urine stiU had occasional tubercle bacilli present. In the
examination the spermatozoa appeared normal, numerous, and negative for tuberculosis.
About three years after the operation, the patient's wife was delivered of a healthy, non-
tuberculous baby. The wife has never had tuberculosis, and the child, now 8 years old,
is still well. Four years ago another healthy child was bom. The father's condition at
present is still one of symptomless, arrested pulmonary and genito-urinary tuberculosis.

Case 2: C. M., a single white lawyer, age 24, was admitted to the hospital on March 8,
1935 with the diagnosis of tuberculosis of the right kidney, bilateral epididymitis, prosta-
titis and calcareous deposits in the seminal vesicles, the latter being diagnosed by roent-
genography and palpation. An operation was deferred three months for sanitorium
treatment. During this time the patient gained 20 pounds in weight, with the symptoms
of urinary frequency subsiding. At the operation a functionless right kidney was removed;
the convalescence was smooth; the wound healed per primum. The patient continued
sanitorium treatment for six months following his discharge from the hospital. A year
later he was married to a healthy wife. An examination then showed no tubercle bacilli
in the urine, and the sperm count and sperm were normal, and negative for tuberculosis.
A healthy child was born, and after ten years is still healthy and free of tuberculosis, as
is his mother. The patient has had an arrested and symptomless tuberculosis for ten
years and during this time has been active in his legal practice.

Case 3: K. E., a married, white, male engineer, and an ambulatory patient with the
diagnosis of chronic bilateral epididymitis, prostatitis and calcification of the seminal
vesicles, was first seen about three years ago. He had a history of six months sanitorium
therapy for genital tuberculosis, two years before his marriage. While tubercle bacilli
were found in the urine at that time, no demonstrable lesions were discovered in the
upper urinary tract. His wife gave birth to two girls at different pregnancies. They are
now healthy and have recently married. The patient is well and symptomless. There is
still no evidence of any pathologic process in the upper urinary tract, but the epididymes

* Read at the Urosurgical Club Meeting, Skytop, Pennsylvania, October 5-8, 1948.
t Received for publication November 30, 1948.

172

TOULSON— SEMINAL VESICUUTIS 173

are thickened; the prostate is small, fibrous and adherent. The seminal vesicles are
palpated as small, irregular, hardened structures with roughened small masses, which
indistinctly are radiable as calcareous deposits. The sperm count and material appears
normal.

The history of these three patients would indicate that genital tubercu-
losis, involving one or both epididymes, the prostate and having calcifi-
cations of the seminal vesicles does not always lead to sterility.

DEPARTMENT OF OBSTETRICS
A CASE REPORT*!

H. S., age 41 years, para 1-0-0-1, was first seen in the Obstetric Clinic when she was
26 weeks pregnant. The family and past histories were entirely negative except that the
patient stated that two years previously a diagnosis of uterine fibroids was made. Surgery
was recommended at that time, but was rejected by the patient.

The past obstetric history showed one normal pregnancy with a spontaneous labor in
1930, resulting in the dehvery of a 10 pound baby. The menstrual history was negative.
Her last menstrual period had been in June and the estimated date of confinement was in
March.

The patient was first seen on December 1. The physical examination revealed a rather
emaciated 41 year old woman who gave evidence of a mild anemia, but no other signs or
sjonptoms of abnormahty. Her blood pressure was 108 systolic over 80 diastohc. An
abdominal examination showed a uterus containing multiple fibroids and was somewhat
larger than the normal duration of pregnancy would seem to indicate. The uterus was
pushed forward and was not tender. The fetal heart beat was present. A pelvic ex-
amination showed the intriotus to be parous. The cervix was closed and patulous with
sHght contact bleeding. A fibroid 3 cms. in diameter was felt in the anterior base of the
right broad hgament; another fibroid about 4 cms. in diameter was felt in the posterior
cervix. Neither of these obstructed the birth canal. The presenting part was dipping
in the pelvis in the left-occiput transverse position. A rectal examination verified the
existence of the fibroids.

DISCUSSION

The discussion of this case may be taken up under three phases: A, the
phase of labor; B, the immediate puerperal period; and C, the puerperium
and later life.

A. This patient, although she has had one 10 pound child dehvered spon-
taneously 18 years ago is now essentially a primigravida, because of the long
interval between pregnancies. It is definitely known that when pregnancy
occurs after long intervals, the outcome is more likely to be hazardous for
both mother and child. In addition, multiple fibroids make dehvery from
below doubtful and a greater risk is involved. This is because the labor
probably wlU be prolonged and desultory as a result of the replacement of
the normal uterine musculature by fibrous tissue. Even though a sterile
pelvic examination revealed no obvious fibroids completely blocking the
birth canal, it is probable that the two which were visualized in the lower
uterine segment might possibly cause an obstruction. In addition the third
stage could well be complicated by a retained placenta which might necessi-
tate manual removal and increased chances of infection and perforation of
the uterus.

* From the Department of Obstetrics, School of Medicine Universit}'^ of Maryland.
t Received for publication February 25, 1949.

174

DEPARTMENT OF OBSTETRICS 175

B. Postpartum blood loss is likely to be increased because of the inability
of the uterine musculature to contract properly for closing off the bleeding
uterine sinuses, thereby necessitating an emergency hysterectomy. It is
likely that in the immediate puerperium a marked subinvolution would
occur, and it is possible to have a degeneration instead of a normal involution
of the fibroids. This would necessitate surgery at some later date.

C. About .8 to 1 per cent of fibroids develop into sarcoma. Since the patient
is in the age group where carcinoma of the cervix is most prevalent, it was
thought that a pan-hysterectomy would probably be the operation of choice.
This decision for a pan-hysterectomy rather than a sub-total hysterectomy
should be held in abeyance until the abdomen is opened and the vascularity
of the pelvis is noted. Should there be marked varices, too many to be con-
sistent with good pelvic surgery, the sub-total rather than the total hysterec-
tomy should be done. Needless to say, the general physical state of the pa-
tient should be improved by any and all means before surgery is done.

SEMIANNUAL REPORT OF THE DEPARTMENT OF
OBSTETRICS*

Jan. 1, 1948 June 30, 1948

FOREWORD

In order that the annual report of the Department of Obstetrics shall
comcide with the house staff year, it has been decided to change the year to
run from July 1st to June 30th. Therefore it becomes necessary to publish
this interim, or six months report.

While preparing this report for pubhcation, several facts became apparent
which seem to need a word or two of explanation. The first is the number
of abortions in private patients in contrast to the service group. The reason
for this is that service abortions are admitted to and treated by the separate
Department of Gynecology. On the other hand a private patient who has
made a reservation at the hospital for deUvery, is automatically admitted
to the Department of Obstetrics in the event that abortion occurs and
hospitalization appears necessary. The latter is usually the case and an
abortion rate of 4.28 per cent among private patients might be considered
to be reasonably accurate.

As in aU clinics, the greater portion of fetal mortality occurred in premature
infants. The total rate in all babies was 38.11 per 1000 live births; among
term babies it was 14.21 and among prematures 313. The mortality in live
births shows the same differences, being 0.63 per cent in term and 14.76 per
cent in premature infants. When the birth weight of the latter was above
2000 grms. only 4.41 per cent failed to survive ; below 2000 grms. this figure
became 31.81 per cent.

There were four maternal deaths in the period covered by this report.
This is very high, and if it were a true representation of our maternal mortal-
ity rate it would be deplorable indeed. This is not the case as indicated by
the fact that in the six months following this report there was only one
maternal death which occurred in a private patient with severe hypertensive
heart disease. Labor began while the patient was in mild decompensation,
and she developed rapid failure and died undelivered.

Of the four deaths occurring in the period covered by this report, all
should be adjudged preventable. In three the blame will have to be placed
upon us, with the possible exception of one patient with eclampsia, who was
unregistered and had received no medical care prior to her admission to the
hospital.

While a report of this kind is an indication of the type of work done in a

* From the Department of Obstetrics, School of Medicine, University of Maryland

176

DEPARTMENT OF OBSTETRICS— SEMIANNUAL REPORT

177

clinic, it is deficient in that it does not permit mention of the ill patients
who, because of good judgment, skillful attention and hard work on the part
of the consultant and house staflFs, recovered and were discharged with their
babies in good condition. Examples of this are fairly numerous and the
credit for the results and my grateful appreciation goes to these two groups.

Louis H. Douglass, M.D.

Professor of Obstetrics

Summary

1. Number of patients discharged.. .

2. Number of patients delivered and

discharged (twins 22 sets) .

a. Patients delivered of viable

infants

b. Patients aborting

3. Maternal mortality

a. Rate per 1000 live births . . .

4. Number of viable babies born . . .

a. Term ;

b. Premature*

5. Number of living babies

a. Term

h. Premature

6. Number of stillbirths

a. Term

b. Premature

c. Rate per 1000 viable births.

7. Number of neonatal deaths

a. Term

b. Premature

c. Rate per 1000 live births. . .

8. Total fetal mortality

a. Rate per 1000 births

* A premature baby is one which

TOTAL

HOME

HOSP. SERVICE

Wh.

Col.

Wh.

Col.

1571

318

194

584

1425

318

167

519

1395

317

161

514

4
2.88

0
0

4
7.88

1417
1282

2
0

318
306

164

147

523
449

135

1388
1273

2
0

314
305

162
146

506

442

115

29
10

0
0

2
1

20.89

12.73

12.27

33.53

25
8

0
0

1
1

4
1

18.01

3.18

23.92

31.55

54
38.11

0
0

5
15.72

6
36.36

33
62.95

474

420

402
18

0
0

410

380

404

380

6
1
5
14.92

4
2
2
9.95

10
24.51

weighs less than 2500 grms. at birth.

178

BULLETIN OF TEE SCHOOL OF MEDICINE, U. OF MD.

Patient Status

Private patients (Twins 8 Sets)

White-registered clinic (Twins 1 Set) . . . .
White-nonregistered clinic (Twins 3 Sets)

Colored registered (Twins 10 Sets)

Colored nonregistered (Twins 0 Sets) . . . .
Total

LIVE
BIRTHS

STILL-
BrETHS

ABORTION

396

127

727

1366

TOTAL
420

135
33

745

1425

Presentation: Premature and Full Term (Delivery Diagnosis)

SPON.
DEL. HOME.

SPON.
DEL. HOSP.

OPERATION
FROM BELOW

OPERATION
EROM ABOVE

TOTAL

Wh.

Col.

WTl.

Col.

Wh.

Col.

Wh.

Col.

Wh.

Col.

Vertex

Face

2
2

318
318

72
1

218
6

224

463
1

17
3
2

486

250
21

1
272

27
27

547

576

813

Breech

Transverse. . . .

Compound

Unknown

Total

841

DEPARTMENT OF OBSTETRICS— SEMIANNUAL REPORT

179

Types of Delivery

1. Spontaneous.

2. Operative

a. Forceps-total

Indications

Control

Presentation occiput pos-
terior

Delivered as such

Following forceps rotation .
Following manual rotation.
Presentation occiput trans-
verse

Following forceps rotation .

Following manual rotation.

Presentation face

Labor prolonged

27
29

704

581

50
9

b. Breech extraction — total

Frank breech

a. Decomposed

Full breech

Primigravida

Multigravida

Head — af tercoming — forceps to

c. Version — internal podalic and breech extrac-

tion— total

Indications

Presentation transverse

Second twin

d. Craniotomy — total
Indications

Disproportion cephalopelvic

e. Other destructive operations — total

Indications and types

Evisceration

Presentation transverse — neglected. . . .

f. Laparotomy (other than cesarean section) —

total

Indications and type

Hysterectomy — supravaginal

Uterus, rupture of — spontaneous

Uterus, rupture of — previous section. . .

g. Cesarean section — all types — total

Wh.

37
129

114
95
12

Col.

542
299

15
16

248

194

17
3

38
372

9
10

354
292

30
6

1
1

10
10

617
800

716

581

38
33

5
20
18

43.57
56.42

50.56

2
1

1 I
41| 2.89

180

BULLETIN OF TBE SCHOOL OF MEDICINE, U. OF MD.

Types of Delivery — Continued

Indications

1. Pelvis contracted

2. Baby — excessive size of

3. Inertia uterine

4. Malpresentation

5. Pelvis — tumor blocking

6. Placenta previa

Centralis

Partialis

Marginalis

7. Placenta — premature separa-

tion of

Complete

Partial

8. Preeclampsia

9. Posteclampsia

10. Eclampsia

11. Hypertensive disease

12. Section previous

a. Disproportion cephalopelvic.

b. Death — fetal — intrauterine
repeated

13. Presentation breech

14. Primigravida elderly

15. Pyelonephritis severe

16. Uterus — rupture of suspected. .

17. Hips — ankylosis of tuberculosis
Totals

m a

SERVICE

PVT.

TO-
TAI,

Wh.

Col.

3
2
1

2
1

1
1

2
2

4
2

1
5

1
1

2
5

2
1

Other Operations and Procedures Not iNCLtrDiNG Delivery

1. Episiotomy — total

a. Central

With rectal laceration

b. Paramedian

With rectal laceration

2. perineorrhaphy — total

a. Indicated (laceration)

b. Elective (old R.V.O.)

3. Trachelorrhaphy

a. Indicated

b. Elective

4. Hysterostomatomy — total

a. Dystocia cervical: forecoming head. . . ,

b. Dystocia cervical: af tercoming head

5. Hysterectomy — total

a. Uterus couvaillaire

b. Uterus — rupture of

c. Uterus — fibroids of

d. For sterilization only

6. Dilatation and curettage — total

a. Secundines retained

b. Mole, hydatidiform

7. Placenta, manual removal of — total

a. Placenta adherent

b. Placenta retained

8. Hematoma, evacuation of

a. Vagina

9. Fetal scalp clamp — appHcation of — total . .

a. Placenta previa

b. Placenta — premature separation of

c. Inertia uterine

d. Following external version for trans

verse he

10. Amniorrhexis for induction of labor— total.. .

a. Preeclampsia

b. Hypertensive disease

c. Placenta previa

d. Placenta — premature separation of

e. Rh negative with antibodies

f . Convenience

181

Wh.

10
13

Col.

239
234

37
13

330
304

26
16

13
3

60
29

27
11

2
11

663
627

36
89

Other Operatioks and Procedures — Continued

11. Sterilization

a. Section previous

b. Multiparity (para 7 or more) .

c. Hypertensive disease

d. Renal disease

e. Pathology cardiac

f. Accompan3dng section

12. Cyst, ovarian — removal of

13. Salpingectomy

14. Mastitis, suppurative — incision of.

15. Uterus — packing of

16. Vagina — packing of

17. Ureters — catherization of

Abortions — total

Therapeutic — total

a. Hypertensive disease

b. Preeclampsia
Spontaneous — total

a. Syphilis — maternal

b. Hypothyroidism

c. Dysfunction — endocrine

d. Fetus — abnormaUty of. .

e. Etiology undetermined . .

f. Cervix — amputation of . .
Requiring completion

Wh.

Col.

48
3
39
4
1
1

18 30

Complications

Maternal

Placental — total

Placenta previa centralis

Placenta previa partialis

Placenta previa marginalis

Placenta, premature separation of.

a. Implanted normally ,

b. Implanted low

Placenta retained

Placenta adherent

Placenta, anomalies of

Cord, prolapse of

36
2

—

1 1

1 '

182

Other Operations and Procedures — Continued

Maternal — Continued
Pelvis contraction of (roentgenologic classi-
fication)

Gynecoid — small

Android

Anthropoid

Platypelloid

Mixed types

Labor

Prolonged

Shock antepartum

intrapartum

postpartum

Uterus — inertia

rupture of

inversion of

Ring contraction

Membranes — rupture of — premature

Dystocia — cervical

Dystocia — shoulder

Hemorrhage and blood dyscrasia

Anemia

Hemorrhage antepartum

intrapartum

postpartum

Rh negative — total

with antibodies

Cardiovascular disease

Rheumatic

Congenital

Toxemia

H)T3ertensive disease

Benign

Mild

Severe

Malignant
Renal disease
Nephrosclerosis
Glomerulonephritis
Acute
Chronic
Nephrosis
Acute
Chronic
Renal disease — other forms

Preeclampsia

Mild

Severe

Wh.

2
13

2
20

Col.

20
3
2
6
4
1

4
2
1

3
39

3
2

63
37
26

38
27

5
3

17
2

31
6
2

12
6
2

4
6
1

18
101

158

130

136

183

Other Operations anb Procedures — Continued

Maternal — Continued

Eclampsia

Convulsive

Nonconvulsive

Vomiting of pregnancy

Unclassified

Infection

Genital tract

Puerperal

Wound-perineal

Others

Respiratory

Pneumonia — aU types

Tuberculosis active

Tuberculosis arrested

Upper respiratory acute

Urinary tract

Pyelitis — antepartum

Pyelitis — postpartum

Cystitis — hemorrhagic — postpartum

Infection miscellaneous

Hydramnios

Mole hydatidiform

Diabetes

Ovary — dermoid cyst of

Hernia — ventral

Condylomata acuminata

Symphysis — subluxation of

Epilepsy

Sacro-iliac joint — subluxation of

Thrombophlebitis — lower extremity

NephroUthiasis

Atelectasis — post-operative

Coccygodinia

Hemiplegia

Fetal

Injury and disease

Hemorrhage intracranial

Atelectasis

Newborn — hemolytic disease of

Pneumonia — broncho

Infection

Diarrhea

Thrush

Impetigo

Scalp-infection of

184

Wh.

Col.

_1
20

45
2
2

4
2
9
2

19
4
1

5
1
1

DEPARTMENT OF OBSTETRICS— SEMIANNUAL REPORT

185

Other Operations and Procedures — Concluded

Fetal — Contintied
Development — abnormalities of. .

Hydrocephalus

Spina bifida

Other:

Polydactylism

Heart disease — congenital

Atresia — gastrointestinal tract.

TaUpes — equino varus

SEHVICE

PVT.

Wh.

Col.

2
1

Total Number of Viable Babies (Twins 22 sets)

Bom alive

1388

HOME DELIVEY

HOSPITAL

DELIVERY

Wh.

Col.

Service

Private

TOTAL

Wh.

Col.

L.
2

4
2
3

2
11

1
1

2
3
4
3

1
9

D.
2

L.
1

7
22
68

Birth weight

less than 1000 grms.*

1000 to 1499 grms

1500 to 1999

3
4
7

2000 to 2499

—

All premature Uve births. . .

Term Uve births (2500 plus
grms.)

302

145

440

378

1265

—

* Lived for 48 hours.

186

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB.

PEEMATUEE LABOR — CAUSES OF

Induced

Toxemia

Preeclampsia

Eclampsia

Posteclampsia

Hypertensive disease

Renal disease

Other toxemias
Hemorrhage

Placenta previa

Placenta — premature separation of.

Other hemorrhages

Spontaneous

Toxemia

Eclampsia

Hypertensive disease

Renal disease

Pyelonephrosis

Other toxemias ■

Preeclampsia

Hemorrhage

Placenta previa

Placenta— premature separation of .

Other hemorrhages
Membranes — premature rupture of . . .

Syphilis

Hydramnios

Pregnancy multiple

Surgery — abdominal

Disease— maternal — acute-infections.
Pathology — cervical

Erythroblastosis

Fetus — abnormalities of

Diabetes — maternal

Fetus — intrauterine death of

Cause undetermined

HOME DEI.IVEEY

Wh.

Col.

HOSPITAl DELTVEEY

Service

Private

Wh.

Col.

11
6

2
2
1

1
29

123

4
1

3"
11

4
2
1

DEPARTMENT OF OBSTETRICS— SEMIANNUAL REPORT

187

Etiology of Neonatal Mortality (Stillbirths and Deaths in Live Born)

Hemorrhage intracranial

Disproportion cephalopelvic

Delivery vertex — traumatic

Delivery breech

Version — internal podalic and ex-
traction
Anoxemia

Placenta — premature separation of.

Placenta previa

Toxemia

Cord — umbiHcal compression of

Complications — medical

Undetermined

Development — anomalies of

Infections

Syphilis

Pneumonia

Septicemia

Diarrhea

Prematurity

Disease — hemolytic — congenital

Miscellaneous

Undetermined

PEEMATtTRE

Home
delivery

Wli,

Col.

Hospital delivery

Service

WB.

Col.

Pri-
vate

FULL TEEM

Home
delivery

Wh.

Col.

Hospital delivery

Service

Wh.

Col.

Pri-
vate

Maternal Morbidity*

HOME DELIVERY

HOSPITAL SERVICE

PRIVATE

TOTAL

M
^

All causes

7
2

6.5%

4.2%
5.7%

4.1%

7.5%
5.7%
3.5%

6.4%

14.2%

13
11

3.1%
2.6%
2.6%

2.9%

48
11

5.7%

Birth canal only

Dehvery spontaneous
DeUvery operative
below

4.3%
3.7%

4.3%

Delivery operative
above

9.4%

* The standard criterion of a temperature elevation to 100.4 degrees or over on any
two days of the puerperium, excepting the day of dehvery, is used.

188

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Maternal Mortality

ADULT DEATHS

Non-maternal mortality

Maternal mortality

Registered clinic patients

Non-registered clinic patients
Private patients

WH.

COL.

TOTAL

0.28
0.22
1.5
0

Mortality Rate per 1000 Live Births

Registered clinic . . .
Non-registered clinic

Combined

Private

TOTAL

RATE

WH.

RATE

COL.

2.3

2.6

30.3

2.9

1.8

KATE

2.6
12.0

3.7

Summary of Maternal Deaths

36508: The patient, a 29 year old, registered, colored, para 1-0-0-1 was admitted March
2, 1948 in early labor. She was put up sterile under saddle block spinal anesthesia at 4:33
P.M. on March 2, 1948. The cervix was supposedly fuUy dilated with the head on the
perineum. The patient vomited about 12 minutes after receiving the spinal anesthesia.
Her blood pressure was 80 systoUc over 60 diastolic. She aspirated some vomitus and
respirations ceased. The patient was quickly aspirated and resuscitated and soon ap-
peared in good condition. Low forceps were applied and the delivery completed with
moderate difl&culty. She was delivered of a fuU term dead male child, weight 4139 grams,
from left occiput anterior at 5: 13 P.M. on March 2, 1948. The third stage was normal.
A total labor of 15 hours and 18 minutes was recorded. Moderate uterine bleeding con-
tinued. The uterus was firm; a cervical inspection was negative. The patient went into
prodromal shock. An exploration of the uterus revealed a rupture just above the internal
OS at the 2 o'clock position into the left broad Ugament. A supravaginal hysterectomy was
performed and the bleeding points were ligated. The patient died at 7 : 00 P.M. on March
2, 1948.

Cause of death: Traumatic rupture of the cervix and uterus in the lower segment. Severe
hemorrhage, following extension of a rupture into the left broad Hga-
ment, and shock secondary to the hemorrhage.
Autopsy: Complete rupture of uterus and cervix on the left and partial rupture on the
right, hematoma into the left broad ligament. Bloody fluid in the peri-
toneum, pleural cavities and precordium, hematoma of the precordium.
Bilateral, physiologic hydronephrosis.
36670: The patient, a 20 year old, unregistered, colored, para 0-0-1-0, was admitted on
March 9, 1948 at 34 weeks gestation, following two convulsions at home during the 2
days prior to admission. She developed nausea, vomiting, headache and generalized
edema. Upon admission to the hospital, a third convulsion occurred. Her blood pressure
was 180 systolic over 120 diastolic. The urine was four plus for albumin. This patient
was sedated with paraldehyde intramuscularly and magnesium sulfate. She was rapidly
digitalized and placed in an oxygen tent. Her condition remained fair until 5:35 A.M.

DEPARTMENT OF OBSTETRICS— SEMIANNUAL REPORT 189

On March 10, 1948 when she began to go into shock. Despite efforts at combating the
shock with plasma, whole blood and oxygen, respirations ceased at 6:00 A.M. on March
10, 1948.

Cause of death: Subarachnoid hemorrhage and antepartum eclampsia.
Autopsy: Thirty-four weeks pregnancy. Focal necrosis of the liver with hemorrhage
(eclampsia). Extensive subarachnoid hemorrhage. Intraventricular hemor-
rhage. Peri-renal edema.
37333: The patient, a 39 year old, white, unregistered, para 8-0-1-8, was admitted to the
hospital on April 7, 1948 at 28 weeks gestation. She was not in labor but had been in
an unconscious state for approximately 2 hours prior to admission. Her blood pressure
was 265 systolic over 165 diastoUc, and the urine was four plus for albumin. These was a
history of chronic hypertension without prenatal care. The patient did not respond to
treatment. She was placed in a Drinker resuscitator without avail. The respirations
ceased at 10:02 A.M. on April 7, 1948.

Cause of death: Severe chronic hypertensive cardiovascular disease with cerebral hemor-
rhage.
Autopsy: Intracrainial hemorrhage of the right frontal lobe, cerebellum and pontine
angle. Cerebral congestion and marked edema. Marked and concentric
cardiac hypertrophy of the left ventriculum. Edema, sUght but generalized.
Twenty-eight weeks pregnancy. Pulmonary congestion and sUght edema.
Partial atelectasis of the lower lobe.
33646: The patient, a 33 year old, obese, stocky, colored registered, para 1-0-0-0 was ad-
mitted at 3 : 00 P.M. on June 3, 1948, at term but not in labor. The membranes had been
ruptured since 8:00 A.M. on June 3, 1948. There was a bad past obstetric history of a 3
day labor and difficult deHvery from below. The baby died 2 days after birth. Labor
began at 5:00 P.M. on June 3, 1948. The patient was given prophylactic penicillin.
There was slow progress with a primary dystocia type of labor. Cephalopelvimetry
revealed a normal, gynecoid pelvis without evidence of cephalopelvic disproportion. A
pelvic examination under sterile technique was done at 7:00 P.M. on June 4, 1948, and
revealed a thick, boggy cervix, 4 to 5 cms. dilated. The position of the child was left
occipito-transverse and the presenting part was 2 cms. above the spines. A diagnosis of
primary uterine inertia, probably the dystocia dystrophy syndrome, was made. The
abdominal route of deUvery was elected. A spinal anesthesia of 10 mgm. pontocaine was
given at 2:00 A.M. on June 5, 1948. The routine Norton extraperitoneal section was
performed with difficulty and the patient dehvered a full term, Uving female child, weight
3827 grams from left occipito-transverse position at 2:55 A.M. on June 5, 1948. The
approximate duration of labor was 58 hours. The placenta and membranes were removed
manually. The uterus was explored at this time, and the findings were negative. The
patient immediately after the third stage suddenly ceased breathing and despite heroic
efforts at resuscitation by the anesthetist could not be revived and was pronounced dead
at 3:15 A.M. on June 5, 1948.
Cause of death: Pulmonary embolus
Autopsy: Permission refused

Note: Reviewed at the Maternal Mortality meeting
Cause of death: Probably spinal anesthesia

PROCEEDINGS

of the
University of Maryland Biological Society

Officers of the Society

Vernon E. Krahl, President Donald E. Shay, Treasurer

School of Medicine School of Pharmacy

Baltimore, Md. Baltimore, Md.

R. Dale Smith, Secretary Ronald Bamford, Secretarial Representative

School of Medicine Department of Botany

Baltimore, Md. College Park, Md.

Councilors
F. H. J. Figge

W. E. Hahn
M. A. Andersch

G. P. Hager

A program meeting of the Society was held on November 17, 1948, in the
library on the third floor of Bressler Research Laboratory. A paper entitled,
"Orthostatic Albuminuria: A Clinical Manifestation of a Syndrome Associ-
ated with an Hereditary Constitutional Abnormahty. Report Based on a
Study of Sixty-nine Cases," was deUvered by Harvey G. Beck and Bentley
Glass.*

ORTHOSTATIC ALBUMINURIA

A Cliotcal Manifestation of a Syndrome Associated With An Hereditary
Constitutional Abnormality Based on a Study of Sixty-nine Cases

Harvey G. Beck and Bentley Glass

There are many theories on the cause of orthostatic albuminuria. The one most fre-
uently mentioned is lumbar lordosis. Others suggested include cardiovascular disturbance,
decreased renal flow, venous hyperemia of kidneys, vasomotor instability, asthenia,
malnutrition, enlarged tonsils, paranasal sinusitis, enteroptosis, psychoneurosis, and
imbalanced autonomic nervous system. A study of sixty-nine clinical cases makes it
clear that all such factors, as well as the orthostatic albuminuria itself, are symptomatic,
and form a well defined syndrome of hereditary nature.

In the 69 cases, among those examined for given symptoms 96 per cent had infected
tonsils and 72.5 per cent had enlarged glands; vasomotor disturbances were present in
94.5 per cent, and orthostatic hypotension in 75 per cent or more of 12 cases checked; a
hypoplastic constitution, marked by hypoplasia of the heart ("drop heart") and of the

large vessels and by great underweight, in 90 per cent (Rohrer's index, where P =

* From the Beck Diagnostic Clinic, Baltimore, and the Department of Biology, Johns
Hopkins University.

190

UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY 191

wt. in gms. and L = ht. in cms. being regularly under 1.2 and often near 1.0); skeletal
anomalies, such as hyperextensile joints, 93.5 per cent, spinal deformity, 93 per cent (with
definite lumbar lordosis in 59 per cent), and characteristic dental defects (maxillary prog-
nathism, etc.), 73.5 per cent. The orthostatic albuminuria is benign, and tends to disap-
pear before 30 years of age.

Studies of the hereditary nature of the syndrome were limited to 4 family groups. In
one, 3 affected children had a mother who exhibited hypoplastic habitus, l3Tnphoid hyper-
plasia, and infected tonsils, but in whom the orthostatic features had presumably disap-
peared before the age of examination. The skeletal habitus is clearly traceable by means
of Rohrer's Index back to the third generation on her side of the family, the father of the
children and his relatives being characterized by high indices (1.55 to 1.72). A second
family, father and mother and 2 sons, clearly shows the transmission of the skeletal and
dental characteristics from the father to both sons. Both of the latter had orthostatic
albuminuria, which had presumably disappeared in the father. In a third family a 15
year old girl with orthostatic albuminuria and the usual syndrome had a father and older
sister without orthostatic albuminuria but able, like the index case, voluntarily to dis-
locate hip, finger, and toe joints. In a fourth family, a woman of 22 with the full syndrome
and a Rohrer's index of 1.10 came from a family with high indices on the paternal side
(1.41 to 1.51), low on the mother's (1.04 to 1.06).

A fuller study of affected families will be needed to confirm and extend the genetic
interpretation of the syndrome. It appears, however, on the basis of the present evi-
dence, to be the result of a simple dominant gene of high penetrance and rather regular ex-
pression.

A program meeting of the Society was held on December 15th, 1948'
in the hbrary on the third floor of Bressler Research Laboratory. A paper
entitled, "Cancer Detection and Therapy : Affinity of Neoplastic, Embryonic,
and Traumatized Tissues for Porphyrins and Metalloporphyrins," was
dehvered by Frank H. J. Figge, Glenn S. Weiland and Louis O. J.
Manganiello.*

CANCER DETECTION AND THERAPY. AFFINITY OF NEOPLASTIC,

EMBRYONIC, AND TRAUMATIZED TISSUES FOR PORPHYRINS

AND METALLOPORPHYRINS

Frank H. J. Figge, Glenn S. Weiland, and Louis O. J. Manganiello

In the course of studies on the cocarcinogenic action of porphyrins, many of the mice
that were injected with methylcholanthrene and porphyrins developed tumors. When
these mice died or were sacrificed, it was noted that the porphyrin which had been injected
intraperitoneally had accumulated and concentrated in the subcutaneous sarcomas to
such a degree that the tumor had become red fluorescent while other normal tissues had
not. The affinity of porphyrins for neoplastic tissue was so striking that it was studied
in some detail. It was realized at the outset that if this affinity of neoplastic tissues for
porphyrins extended also to metalloporphyrins and thus to radioactive metaUoporphyrins,
and proved to be generally true for all tumors, then this class of substances could be
utilized to improve the existing methods of cancer detection and therapy.

* From the Departments of Anatomy and Biochemistry, School of Medicine, Uni-
versity of Maryland and City Hospital, Baltimore.

192 BULLETIN OF THE SCBOOL OF MEDICINE, U. OF MD.

The present report is based on observations made on 240 tumor bearing and 50 non-
tumor bearing mice. The neoplasms studied included methylcholanthrene-induced
tumors (spindlecell fibrosarcomas and rhabdomyosarcomas), transplanted fibrosarcomas,
spontaneous mammary carcinomas and transplanted mammary adenocarcinomas (variable
type) that developed in this laboratory.

These experiments show that aU porphyrins tested accumulate in neoplastic (induced
and transplanted sarcomas, spontaneous and transplanted mammary carcinomas), em-
bryonic and regenerating tissues. Introduction of a metal (zinc) into the porphyrin
molecule did not destroy the tendency of the porphyrin to concentrate in tumors. The
tendency of injected porphyrins and metalloporphyrins to accumulate in lymph nodes may
limit the therapeutic usefulness of these compounds in all neoplastic diseases except
lymphatic leukemias. The possibility of using small doses of radioactive metallopor-
phyrins for detecting deep cancer is being investigated.

A program meeting of the Society was held on January 19th, 1949, in
the Kbrary on the third floor of Bressler Research Laboratory. A paper
entitled, "An Apparent Massive Histamine Mobilization, (Only in Canine
and Related Species), Upon Injection of Tweens," was deUvered by Joseph
Gordon Bird.*t

AN ANAPHYLACTOID REACTION PECULIAR TO CANINE ANIMALS

Joseph Gordon Bird

Substances known as Tweens have come into prominence in bacteriology, pharmaceu-
tic preparations, and in increasing absorption of fats and fat-soluble vitamins where for
various reasons such absorption is poor.

A remarkable shock, with the liberation of a histamine-Uke compound into the blood,
is routinely produced in dogs, foxes, and wolves, by the intravenous injection of these
Tweens. Unanesthetized dogs present immediate flushing of the skin, scratching, weak-
ness, instability, vomiting, and defecation. They are apparently recovered after 1 to 3
hours. The blood pressure of all canines is slowly lowered during the second and third
minute after injection to levels averaging about 50 per cent of normal. Many animals
show pressures of 20 to 40 mm. Hg. This lowered pressure is probably the result of wide-
spread dilatation of capillaries caused by the Hberation of histamine. The pressure begins
rising usually within one-half to one hour, and reaches normal within one to three hours.
A fox seemed especially sensitive, and died soon after his blood pressure decKned to an
extremely low level. The type of anesthesia has no marked effect upon the results.

All dogs subjected to intradermal testing with Tween in dilutions of 1:200 to 1:2000
have shown typical wheals. No reactions have been obtained in man, rats, and guinea
pigs. Intravenous Tween injections have not produced the above systemic reaction in
cats, rats, rabbits, monkeys, chickens, guinea pigs, or man.

* From the Department of Pharmacology, School of Medicine University of Mary-
land.

t This work was done by Drs. John C. Krantz, Jr., C. Jelleff Carr and Sally Cook,
Mr. W. G. Hame and the author of this abstract.

ALUMNI ASSOCIATION SECTION

DR. WYLIE APPOINTED DEAN

Hamilton Boyd Wylie became the twenty-eighth Dean of the University
of Maryland School of Medicine by appointment of the Board of Regents on
June 15, 1948.

Dean Wylie was born in Baltimore, Maryland, on May 3, 1887, the son
of Dr. Hamilton Boyd Wylie, Sr., (P. and S. 1876) and Carrie S. Wylie.
His early education was received at Deichmann's preparatory school and his
professional training at Johns Hopkins University. In 1908 he entered the
Baltimore Medical College, graduating in 1912. While a student, he won
the Gehrmann Scholarship and was awarded the Dissecting Prize in Anatomy.

Following his graduation, he became associated with the Baltimore Medi-
cal College as a member of its faculty serving in the Departments of Physio-
logical Chemistry and Pharmacology and, at the same time, assisting in the
clinical laboratory at the Maryland General Hospital.

At the time of the merger of the Baltimore Medical College with the
University of Maryland in 1913, he was appointed Assistant in Biochemistry,
later becoming Professor and Head of the Department of Biochemistry in
1919. He held this office until his appointment as Dean, being succeeded
at this time by Dr. Emil G. Schmidt.

It was only a short while after his coming to the University of Maryland
that the advent of World War I, and a shortage of instructors, placed upon
him the difficult task of teaching during a critical period and in a number of
varied subjects. During the war years he taught classes in Materia Medica,
Physiological Chemistry and Clinical Pathology. He assisted Dr. William
Royal Stokes in the Pathology Department along with added duties under
Dr. Samuel J. Fort in Pharmacology. This strenuous schedule provided
for him a wealth of experience upon which were founded the sound principles
of organization and teaching in the Department of Biochemistry. During
the 29 years of professorship, his ability and interest in departmental or-
ganization and medical education resulted in a department which became a
model of its type. Not only did his interest center in the teaching of medical
students but, during these years, either by direct contribution or in coopera-
tion with members of his department were produced a number of important
scientific papers relating principally to the chemistry of the oestrogens and
techniques for their assay.

His aptitude and interest in administrative functions led ultimately to
the development of the Committee on Admissions, of which he is chairman,
and to his appointment as Acting Dean. During his chairmanship of the
Committee on Admissions, extensive revisions were effected in the manner

193

194 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

of selection and admission of students with results which have been most
gratifying to all. His appointment as Dean, therefore, climaxes a long period
of service as instructor, department head and administrator. Under his
guidance and supervision, already, measurable changes have been effected
in the Medical School organization by careful selection and delegation of
responsibility where the best interests of efficient administration might be
served.

Following the adoption of an Act by the Maryland Legislature relating to

DR. H. BOYD WYLIE

medical care for the indigent through the use of public funds, Dean Wylie
contributed heavily to the organization and the program for the installation
of the Medical Care Clinic at the University of Maryland and the integration
of the University Hospital services with this basic unit. He is a member of
the Medical Advisory Board of the Baltimore City Hospitals, the Baltimore
City Advisory Counsel for Medical Care of the City Health Department,
Chairman of the local Dean's Committee of the Veterans Administration,
and Secretary-Treasurer of the Trustees of the Endowment Fund of the
University of Maryland. He is a member of Phi Gamma Delta Fraternity,
the Phi Chi Medical Fraternity, the Medical and Chirurgical Faculty of

NEWS ITEMS 195

Maryland, The American Association for the Advancement of Science, and
Sigma Xi.

NEWS ITEMS

Dr. W. Houston Toulson, Professor of Genito-Urinary Surgery, University
of Maryland 1913, has been made President of the Medical and Chirurgical
Faculty for its Sesquicentenial year.

Dr. Albert E. Goldstein, P. and S. 1912, has been elected to the Presi-
dency of the Baltimore City Medical Society, as of January 1, 1949. On
January 6, 1949, at a post graduate seminar in Genito-Urinary Surgery,
Dr. Goldstein did several urologic operations which were televised. This
was done in connection with the University of Buffalo.

ANNOUNCEMENTS

The School of Medicine of the University of Maryland is very desirous of
making additions to its collection of old, as well as recent, obstetric instru-
ments.

Any contributions of forceps of historical interest will be gratefully received
and acknowledged by being appropriately labeled with the donor's name and
displayed in a suitable exhibition case. Please communicate with Dr. Louis
H. Douglass, Department of Obstetrics, if you have any such material to con-
tribute.

NOTICE OF REUNION AND ALUMNI DAY

Advance notice is given herewith of the program for the annual Medical
Alumni Day.

This year the plans will include the presentation of the Alumni Honor
Award for distinguished contribution to medical science by an outstanding
alumnus of the Medical School. There wiU be the usual Alumni reunions,
a luncheon, the annual meeting of the Association, an interesting scientific
program and the traditional Alumni banquet.

ALUMNI DAY WILL BE FRIDAY, JUNE 3, 1949

Class reunions this year will be held for the following classes: 1944; 1939;
1934; 1929; 1924; 1919; 1914; 1909; 1904; 1899. Representatives and class
organizations wiU receive all possible aid in organizing class reunions by
applying to the Alumni office.

Again, the Alumni office will secure hotel reservations for you in Baltimore
upon proper application.

Further details of the program, reservation blanks for hotel accommoda-
tions and banquet tickets will be forwarded directly to you at a later date.

196 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

MEDICAL ALUMNI DAY— UNIVERSITY OF MARYLAND— JUNE 3, 1949

POST GRADUATE COURSE

BASIC SCIENCES AS THEY APPLY TO GYNECOLOGY AND

OBSTETRICS

A full-time post graduate course will be presented as a review in the funda-
mentals of the basic sciences for physicians who are preparing for the Board
examinations in Obstetrics and Gynecology. It is designed to acquaint them
with the recent advances in these fields related to their interests. Lectures,
laboratory periods, seminars and demonstrations will be given by the
Faculty of the School of Medicine, University of Maryland. The course
has been approved by the Post Graduate Survey Committee of the American
Board of Obstetrics and Gynecology, and may be presented for six months'
credit towards certification by the Board.

Instruction begins the first week in October and will continue full time for
a period of twenty weeks. Only those men will be accepted who hold an
M.D. degree from an approved Medical School and who have an appoint-
ment in, or who have served, an assistant residency or preceptorship ap-
proved by the American Board of Obstetrics and Gynecology. When
possible, a personal interview is desirable. Enrolment is limited. Tuition
$375.00

Address all inquiries for further information or requests for application
forms to the Oflace of Post Graduate Studies, University of Maryland, School
of Medicine, Baltimore 1, Maryland, before May 1, 1949.

MEDICAL LIBRARY RARE BOOK RESTORATION FUND

Alabama Delaware

Birmingham, A. C. Fields, M.D. Wilmington, Lang W. Anderson, M.D.

Charles B. Leone, M.D.
California Edgar R. Miller, M.D.

Glendale, Kenneth P. Nash, M.D. Washington, D. C.

Los Angeles, Vincent Bonfiglio, M.D.

Pasadena, Edward D. Ellis, M.D. C. Whitridge Lee Briscoe

Redlands, D. C. Mock, M.D. Edna G. Dyar, M.D.

Julian M. Gillespie, M.D.
Connecticut Louis H. Schuman, M.D.

Bridgeport, John F. Quinn, M.D. Georgia

Daniel F. Keegan, M.D.
New Haven, Frank Di Stasio, M.D. Milledgeville, Richard Binion, Sr., M. D.

ALUMNI NEWS

197

Illinois

Chicago, Maurice Feldman, Jr., M.D.
Herrin, W. R. Gardiner, M.D.
Robinson, A. G. Brooks, M.D.

Indiana

Indianapolis, Max R. Bloom, M.D.

Maine

Lubec, D. F. Bennet, M.D.
Rockland, H. V. Tweedie, M.D.

Maryland

Annapolis, Robert S. G. Welch, M.D.
Baltimore, Conrad Acton, M.D.

Margaret Ballard, M.D.

Eugene S. Bereston, M.D.

Harrj^ C. Bowie, M.D.

Otto C. Brantigan, M.D.

Ruth Lee Briscoe

William R. Bundick, M.D.

Edward F. Cotter, M.D.

Louis H. Douglass, M.D.

Francis A. Ellis, M.D.

Maurice Feldman, M.D.

Samuel L. Fox, M.D.

Edward L. Frey, Jr. M.D.

Samuel S. Glick, M.D.

Albert E. Goldstein, M.D.

K. Golley, M.D.

Rachel K. Gundry, M.D.

Jeanette R. Heghinian, M.D.

Mary Elizabeth Hicks

Harry C. Hull, M.D.

J. Mason Hundley, M.D.

Charlotte M. Jubb

D. Frank Kaltreider, M.D.

Melvin D. Kappelman, M.D.

Albert H. Katz, M.D.

Florence R. Kirk

George A. Knipp, M.D.

Carroll G. Lockard, M.D.

Edith R. Mcintosh

Hugh B. McNaUy, M.D.

Karl F. Mech, M.D.

Israel P. Meranski, M.D.

John A. Myers, M.D.

Maurice Pincoffs, M.D.

Samuel T. R. Revell, M.D.

Ida Marian Robinson

J. M. H. Rowland, M.D.

Milton S. Sacks, M.D.

John E. Savage, M.D.

E. G. Schmidt, M.D.

S. Sherman, M.D.

A. J. Shochat, M.D.

Milton Siscovick, M.D.

Samuel Snyder, M.D.

E. Howard TonoUa, M.D.

Grant E. Ward, M.D.

William E. Weeks, M.D.

Alex A. Weinstock, M.D.

Gibson J. Wells, M.D.

A. L. Wilkinson, M.D.

H. Boyd WyUe, M.D.

Israel S. Zinberg, M.D.
CoUege Park, H. C. Byrd, LL.D., D.Sc.
Cumberland, S. M. Jacobson, M.D.
B. Skitarelic, M.D.
Howard L. Tolson, M.D.
Hagerstown, W. Howard Yeager, M.D.
Hyattsville, W. B. Moyers, M.D.
Laurel, B. P. Warren, M.D.
J. M. Warren, M.D.
Owings Mills, Ethel C. Rider
Pocomoke City, N.E. Sartorius, Sr., M.D.
Queenstown, W. C. Lowe, M.D.
Randallstown, William E. Martin, M.D.
Relay, George G. Schlesinger, M.D.
Westminster, Charles R. Foutz, M.D.

Massachusetts

Anthol, Francis A. Reynolds, M.D.
Boston, H. J. MacLean, M.D.
Fall River, A. C. Lewis, M.D.
Greenfield, John E. Moran, M.D.
Pittsfield, David B. Greengold, M.D.

Michigan

Detroit, William E. E. Tyson, M.D.

Missouri

St. Louis, Samuel J. King, M.D.

New Jersey

Atlantic City, E. Harrison Nickman,

M.D.
Bayonne, S. J. Penchansky, M.D.
Califon, Vladimir F. Ctibor, M.D.
Elizabeth, Arturo R. Casilli, M.D.

198

BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Jersey City, Arthur M. Kraut, M.D.

Robert Rubenstein, M.D.
Victor Wagner, M.D.
Matawan, S. N. Lazow, M.D.
Newark, N. A. Antonius, M.D.

Samuel Geller, M.D.

Joseph Levin, M.D.

Charles A. Wallack, M.D.

Jacob Schmukler, M.D.
Paterson, J. J. Greengrass, M.D.

Joseph L. Polizzotti, M.D.

Harold M. Stein, M.D.
Washington, W. H. Vamey, M.D.

New York

Albany, Morton L. Levin, M.D.
Arveme, L. I., Henry Gordon, M.D.
Bronx, Jack Fein, M.D.

Bernard Friedman, M.D.
Joseph W. Wilner, M.D.
Brookl)T], Bernard Friedman, M.D.
A. R. Fritz, M.D.
J. D. Fritz, M.D.
Harry Gibel, M.D.
Alex B. Goldman, M.D.
D. F. MauriUo, M.D.
Leonard Posner, M.D.
A. H. Salzberg, M.D.
H. Melmuth Sternberg, M.D.
Aaron H. Trynin, M.D.
John Zaslow, M.D.
Samuel Zeiger, M.D.
Ehnhurst, M. L. Kenler, M.D.
Jackson Heights, Aaron Feder, M.D.
Jamaica, J. Savin Garber, M.D.
Long Beach, L. L, Joseph G. Zimring,

M.D.
Marrick, R. R. Mirow, M.D.
New York, Nathan Bercovitz, M.D.
I. C. Bronstein, M.D.
Abraham A. Clahr, M.D.
Harry R. Fisher, M.D.
N. J. Gould, M.D.
James C, Joyner, M.D.
Sylvan Keiser, M.D.
Samuel Marton, M.D.
Kermit E. Osserman, M.D.
Max Trubek, M.D.
F. N. WileUa, M.D.
Kazuo Yanagisawa, M.D.

Schenectady, H. D. Vincent, M.D.
Westfield, Leo H. Salvati, M.D.
Yonkers, Robert V. Minervini, M.D.
Jack H. Woodrow, M.D.

North Carolina

Gibson, E. A. Livingston, M.D.
Mt. Gilead, S. Walker, M.D.

Ohio

Massillon, R. R. Reynolds, M.D.
Toledo, Bernard Botsch, M.D.

Pennsylvania

Butler, Abraham Cellar, M.D.
Chambersburgj B. H. Long, M.D.
Landisville, J. T. Herr, M.D.
Masontown, John L. Messmore, M.D.
Philadelphia, W. Wayne Babcock, M.D.
Samuel Geller, M.D.
Charies A. WaUack, M.D.
Pittsburgh, A. A. Kreiger, M.D.

Isadore Pachtman, M.D.
R. F. Rohm, M.D.
Steelton, Martin F. Kocevar, M.D,

W. P. Dailey, M.D.
York, Kenneth L. Benfer, M.D.
Louis V. Williams, M.D.

Puerto Rico

Santurce, San Juan, Rafael A. Vilar,
M.D.

Rhode Island

Bristol, John R. Bernardo, M.D.
Pawtucket, Patrick A. Durkin, M.D.
Providence, Vincent J. Oddo, M.D.
Charles Zurawski, M.D.

Virginia

Portsmouth, George Hopkins Carr, M.D.

Washington

Seattle, Warren E. Calvin, M.D.
Spokane, Kenneth L. Benfer, M.D.

West Virginia

Clarksburg, H. H. Hajmes, M.D.

OBITUARIES

Dr. Joseph Enoch Gichner, class of 1890, died in his home at the age of 85
on March 8, 1949 of arterio-sclerosis. Dr. Gichner was born in BieHtz
(now Bielsko), Austria-Hungary (now Poland) in August 1864. He was
one of eleven children. At seventeen he came to America with his brother,
where they established a farm near Alexandria, Virginia. As a result of a
bad season and a fire, which destroyed their home, the two brothers gave
up farming. Joseph went to Alexandria where he read medicine with a
local physician, and later matriculated at the University of Maryland
School of Medicine in 1890.

199

200 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

After graduating, Dr. Gichner established a practice in Baltimore and took
active part in University affairs, as well as developing local, state wide and
national interests in medicine. He purchased the second roentgenographic
apparatus in Baltimore City and worked with this machine until he
developed a keratosis on one hand, after which he abandoned the work and
devoted himself to the practice of medicine. In 1911 he returned to
Germany for post graduate work.

For many years he had charge of the Typhoid Service at the University
Hospital. He was the last charter member of the Public Bath Commission,
a post he held for forty nine years. Dr. Gichner became associated with
Dr. William A. Welch in starting the Maryland Tuberculosis Association
which later became affiliated with the National Tuberculosis Association.
Dr. Gichner taught the first regular course in Physical Therapy at the
University of Maryland.

He also held the following positions on the staff of the School of Medicine:
1894-1900— Lecturer on CHnical Medicine
1900-1905 — Associate Professor of Clinical Medicine
1906-1910— Clinical Professor of Medicine
1910-1914 — Clinical Professor of Medicine and Associate Professor of

Materia Medica
1914- Professor of Clinical Medicine and Physical Therapeutics.

On July 1, 1947 Dr. Gichner was made Professor Emeritus.

Also Dr. Gichner was an Associate Editor of the Maryland Medical
Journal.

He always kept faith with his patients, often declaring, 'Tllness is no
social event." He was known for his kindness, quick alertness and active
interest in every phase of medicine. Unfortunately his leg had to be ampu-
tated as a result of arterio-sclerosis in his later seventies. In spite of this
he was a familiar sight at the University up to two months before his death.

OBITUARIES

Albin, Abner Osbum, Charles Town, W. Va.; P & S, class of 1903; aged

72; died, November 15, 1948, of carcinoma.
Ballard, Samuel Edward, Long Beach, Calif.; B. M. C, class of 1899

aged 74; died, September 20, 1948, of coronary occlusion.
Barry, Cornelius B., Woonsocket, R. I.: P & S, class of 1907; aged 69

died recently.
Faunce, Calvin Barstow, Jr., Boston, Mass.; B.M.C., class of 1904

aged 67; served during World Wars I and II; died, September 22,

1948.
Geatty, John Sterling, New Windsor, Md.; class of 1906; aged 66; died,

September 17, 1948.

OBITUARIES 201

Hall, John Pugh, Pittsburgh, Pa.; P & S, class of 1892; aged 81; served

during World War I; died, October 21, 1948.
Hartman, Harvey Wesley, Keyport, N. J.; P & S, class of 1904; aged 67;

served during World War I; died, October 8, 1948, of coronary

thrombosis.
Heterick, Horace Bruce, Wellsville, Pa,; class of 1888; aged 81; died,

August 11, 1948, of arteriosclerosis.
Hill, Milton P., Baltimore, Md.; B.M.C., class of 1906; aged 64; died,

October 9, 1948, of cerebral hemorrhage.
Jessunin, Samuel Haimes, Newark, N. J.; P & S, class of 1900; aged

70; died, September 18, 1948, of leukemia.
Lloyd, Rossiter J., Olyphant, Pa.; B.M.C., class of 1897; aged 70; died,

October 28, 1948.
Lutz, Jeremiah Fletcher, Glen Rock, Pa.; P & S, class of 1894; aged 75;

served during World War I; died, September 11, 1948, of arterio-
sclerosis.
Martin, Seth Heustis, Morrisville, Vt.; B.M.C., class of 1910; aged 66;

died, October 27, 1948, of hypertension and arteriosclerosis.
McElwee, Ross S., Statesville, N. C; class of 1909; aged 68; died,

September 8, 1948, of carcinoma.
McGarrah, Harvey Benton, Fairbank, Pa.; B.M.C., class of 1893; aged

82; died, August 24, 1948, of arteriosclerosis.
Miner, Walter N., Calais, Me.; B.M.C., class of 1898; aged 76; died,

July 15, 1948, of angina pectoris.
Morrison, Elmer J., Bar Harbor, Me.; P & S, class of 1898; aged 86;

served during World War I; died, November 5, 1948.
Mimger, Ray Thomas, Plainfield, N. J.; B.M.C., class of 1909; aged 63;

died, September 19, 1948.
Ward, Horace William, Winsted, Conn.; B.M.C., class of 1903; aged 69;

died, November 11, 1948, of chronic nephritis, arteriosclerotic

heart disease and essential hypertension.
Weller, John H., State Farm, Mass.; P & S, class of 1909; aged 69;

died, November 19, 1948, of heart disease.

INDEX TO VOLUME 33

Alumni Association Section 61, 107, 156, 193

Babcock, W. Wa3me 114

Baldwin, Ruth W 148

Blum, Louis V 148

Brantigan, Otto C 1

Breast surgery, frozen section service in, at the University Hospital, WiUiam L. By-

erly and Dexter L. Reimann 101

Bubert, Howard M 103

Bursitis, pharyngeal, a case report, Frederick T. Kyper and Richard J. Cross 35

Byerly, William L 101

Commencement address, Louis A. M. Krause 122

Cross, Richard J 35

Cryptorchidism, a preliminary report on treatment by ligation of the inferior epigas-
tric vessels, Erwin R. Jennings and Cyrus F. Horine 144

Cunnick, Paul C 1

Cunningham, R. M 127

Dane, Edwin O 70

Department of Obstetrics, School of Medicine, University of Maryland, 1947 Annual

Report 41

Department of Obstetrics, School of Medicine, University of Maryland, Report for

Jan. 1, 1948-June30, 1948 176

DeVincentis, Michael L 8

Electroencephalogram as a diagnostic adjunct: an analysis of five hundred tracings,

George W. Smith, Leah Miller Proutt, and Robert H. Oster 159

Epiphysis, upper femoral, early diagnosis of slipping of the, Robert B. Mearns 26

Femoral neck osteotomy, a treatment for severe sUpped capital femoral epiphysis,
Herbert R. Markheim 136

Fertility, preservation of, in calcerous tuberculous seminal vesiculitis, W. Houston
Toulson 172

Gareis, L. Calvin 18

Gichner, Joseph Enoch — Obituary 200

Goldsmith, Selma Rosenberg 103

Histoplasmin sensitivity among 143 patients at the University of Maryland Childrens

Dispensary, Louis V. Blum and Ruth W. Baldwin 148

Horine, Cyrus F 144

Ileitis, regional, Edwin O. Daue 70

Jennings, Erwm R 144

203

204 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.

Krause, Louis A. M 122

Kyper, Frederick T 35

Liposarcoma, retroperitoneal, a case report, Paul C. Cunnick 168

Mace, John, Jr 99

Markheim, Herbert R 136

Maryanov, Lawrence 99

McCabe, Edward S 8

Meams, Robert B 26

Medical Library Rare Book Restoration Fund 197

Medical pattern, the changing, W. Wayne Babcock 114

Monthly Meetings of the University Hospital Staff:

A comparative study of cyclic and noncyclic hydrocarbons on cardiac automa-

ticity, C. Jelleff Carr and John C. Krantz, Jr 58

An anaphylactoid reaction peculiar to canine animals, Joseph Gordon Bird 192

An experimental study of gastric emptying in the vagotomized dog, Maurice Feld-

man and Samuel Morrison 59

Anatomical evaluation of jet injection instruments, Frank H, J. Figge 59

Attempts to evaluate the influence of penetrating radiations on carcinogenesis,

Frank H. J. Figge 58

Cancer detection and therapy. Affinity of neoplastic, embryonic, and trauma-
tized tissues for porphyrins and metalloporphyrins, Frank H. J. Figge,

Glenn S. Weiland, and Louis O. J. Manganiello 191

Electrical studies on the physiology and pharmacology of the synapse, Amedo S.

Marrazzi 154

Genetic research on the Rh blood types and the relation of Rh incompatibiUty

to abortion, Bentley Glass 55

Orthostatic albuminuria, Harvey G. Beck and Bentley Glass 190

Some observations on the physiology of the fish thyroid, Dietrich C. Smith and

Samuel A. Matthews 57

The effect of insuHn on motility of the stomach following bilateral vagotomy,
Maurice Feldman and Samuel Morrison 59

Nephritis, chronic, in pregnancy, with special reference to the diagnosis, L. Calvin
Gareis 18

Obituaries 62, 126, 157, 201

Obstetric case history 40, 105, 152, 174

Oster, Robert H 159

Pierpont, Ross Z 1

Pollen counts, Howard M. Bubert and Selma Rosenberg Goldsmith 103

Pregnancy, chronic nephritis in, with special reference to the diagnosis, L. Calvin

Gareis 18

Pregnancy, toxemias of, preventions of the, John E. Savage 63

Proutt, Leah Miller 159

Salivary glands, mixed tumors of the, Michael DeVincentis and Edward S. McCabe ... 8
Presentations, face and persistent brow, J. King B. E. Seegar, Jr 87

INDEX TO VOLUME 33 205

Reimann, Dexter L 101

Savage, John E 63

Seegar, J. King B. E., Jr 87

Smith, George W 159

Sotradecol, a new sclerosing agent, a report on the use of, Ross Z. Pierpont and Otto

C. Brantigan 1

Streptomycin, the present status of, in the treatment of tuberculosis, Hugh C. White-
head 79

Streptomycin, the use of, in tuberculous peritonitis, a report of one case, John Mace,

Jr. and Lawrence Maryanov 99

Tetraethylammonium versus novocaine block of sympathetic ganglia, R. M. Cunning-
ham 127

Toulson, W. Houston 172

Tumors, mixed, of the salivary glands, Michael L. DeVincentis and Edward S. Mc-
Cabe 8

Whitehead, Hugh C 79

Wolfe, William D— Obituary 126

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BULLETIN

OF THE

SCHOOL ^/MEDICINE

UNIVERSITY OF MARYLAND

September, 1948

Announcements for

The One Hundred Forty-Third Academic Session
1948-1949

Catalogue of

The One Hundred Forty-Second Academic Session

1947-1948

CONTENTS

PAGE

Calendar July 1948-June 1950 4

Calendar of events for 1948-1949 5

Organization 7

Board of Regents 7

Faculty of Medicine 8

Fellows 18

University Hospital 18

Executive Committee 18

Hospital Staff 19

Resident and Intern Staff 20

Dispensary Staff 22

Dispensary Report 26

Mercy Hospital 27

Hospital Staff 27

Resident and Intern Staff 31

Dispensary Staff 32

Dispensary Report 34

Baltimore City Hospitals — Staff 35

Keman Hospital — Staff 36

The School of Medicine 37

History 37

Buildings and Facilities 38

Requirements for Admission 43

Application 43

Minimum Requirements 43

Combined Course in Arts and Sci-
ences, and Medicine 44

State Medical Student Qualifying Cer-
tificates 45

Definition of Residence Status 45

Current Fees 46

Rules for Payment of Fees 46

Penalty for Non-Payment of Fees 46

Reexamination Fee 47

Student Activities and Service Fee .... 47

Student Health Service 47

General Rules 48

Housing 48

Parking 48

Prizes 50

Scholarships 50

Loan Funds 53

Organization of the Curriculum 53

Anaesthesiology 80

Art as Applied to Medicine 80

Bacteriology and Immunology 57

Biological Chemistry 57

Clinical Pathology 63

Dentistry 75

FACE

Dermatology and Sj^ihilology 67

First Aid 76

Gastro-Enterology 63

Geni to- Urinary Surgery 72

Gross Anatomy 54

Gynecology 77

Histology and Embryology 55

History of Medicine 80

Hygiene and PubUc Health 66

Industrial Medicine and Surgery. ... 75

Legal Medicine 67

Medicine 59

Neuro-Anatomy 56

Neurological Surgery 73

Neurology 66

Obstetrics 76

Oncology 74

Ophthalmology 78

Orthopaedic Surgery 71

Otology 73

Pathology 58

Pediatrics 65

Pharmacology 57

Physiology 56

Plastic Surgery 76

Postgraduate Courses 81

Proctology 73

Psychiatry 64

Rhino logy and Larj'^ngology 71

Roentgenology 79

Surgery 6^8

Schedules of Courses S3

Graduates, June 5, 1948 89

Internships, Graduates of June 5,

1948 90

Matriculates, September 18, 1947 to June

5, 1948 91

Post Graduate Students, July 1, 1947

to June 30, 1948 97

Suramar}^ of Students, September 18,

1947 to June 5, 1948 100

Geographical Distribution of Students,
September 18, 1947 to June 5, 1948 100

Medical Alumni Association 100

Endowment Fund 101

University of Mar\'land School of

Nursing 102

Mercy Hospital School of Nursing 102

Index of Names 103

CALENDAR

1948

1949

1950

JULY

JANUARY

JULY

JANUARY

S
1

F
1

S
2

S
1

W
4

S
7

23
30

24
31

AUGUST

FEBRUARY

AUGUST

FEBRUARY

2
9

3
10

4
11

5
12

6
13

7
14

2
9

3
10

4
11

5
12

2
9

3
10

4
11

5
12

1
8

2
9

3
10

4
11

SEPTEMBER

MARCH

SEPTEMBER

MARCH

2
9

3
10

4
11

■'7

2
9

3
10

4
11

5
12

1
8

2
9

3
10

1
8

2
9

3
10

4
11

....

OCTOBER

APRIL

OCTOBER

APRH.

1
8

S
2
9

S
1
8

NOVEMBER

MAY

NOVEMBER

MAY

DECEMBER

JUNE

DECEMBER

JUNE

2
9

3
10

4
11

1
8

2
9

3
10

4
11

2
9

3
10

2
9

3
10

*■

1 1 ' 1

•■•-, '. :. • ;:■ 1

CALENDAR

Academic Year — September 16, 1948 to June 4, 1949

1948
September 8, 9, 10

Re-examinations for advancement.

FIRST SEMESTER— September 16, 1948 to January 22, 1949

September 14 Tuesday

September 15 Wednesday

September 16 Thursday

November 24 Wednesday

November 29 Monday

December 22 Wednesday

January
January

January

February

April

April
May
May
May

May
May
June

1949

3 Monday
17 Monday
to
22 Saturday

24
21
22
23
13

*Registration, payment of fees, freshmen and sophomores.
*Registration and payment of fees by all other students.
Instruction begins at 8:30 A.M.
Instruction suspended at 5:00 P.M.

Thanksgiving Holidays
Instruction resumed.
Instruction suspended at 5:00 P.M.
Christmas Holidays

Instruction resumed.
Midyear examinations, all classes.
*Payment of fees for second semester.
First semester completed 2:00 P.M.

SECOND SEMESTER— January 24 to June 4, 1949

Monday Instruction begins at 8:30 A.M.

Monday Instruction suspended at 5:00 P.M.

Tuesday Holiday — Washington's Birthday

Wednesday Instruction resumed.
Wednesday Instruction suspended at 5:00 P.M.

Easter Holidays
Thursday Instruction resumed.
Monday Senior examinations begin.

Monday Junior examinations begin.

Monday Junior examinations continue.

Sophomore and Freshmen examinations begin.
Saturday Announcement of graduates.

Monday Holiday — Memorial Day

Saturday Commencement

Second semester completed at 12 :30 P.M.

PARTIAL CALENDAR FOR 1949-1950

1949
September 7, 8, 9
September 13 Tuesday

September 14
September 15

Wednesday
Thursday

Re-examinations for advancement.
*Registration and payment of fees by freshmen and

sophomores.
*Registration and payment of fees by all other students.

Instruction begins at 8:30 A.M.

* A student who fails to register prior to or within the day or days specified will be
called upon to pay a late registration fee of five dollars ($5.00). The last day of registra-
tion with fee added to regular charges is Saturday of the week in which registration begins.

The offices of the registrar and comptroller are open daily from 9:00 A.M. to 5 : 00 P.M.,
and Saturday from 9:00 A.M. to 12:00 noon.

ORGANIZATION

THE UNIVERSITY OF MARYLAND
Harry Clifton Byrd, B.S., LL.D., D.Sc, President and Executive Officer

BOARD OF REGENTS

WiLLL^M P. Cole, Jr., Chairman Baltimore

Stanford Z. Rothschild, Secretary Baltimore

J. Milton Patierson, Treasurer Baltimore

Edward F. Holter MiddletowTi

E. Paul Kicotts Denton

Glknn L. Maetin' Baltimore

Ch.'UULES p. McCormick Baltimore

Harry H. Nuttle Denton

Philip C. Turner Baltimore

Millard E. Tydinos Washington, D. C.

Mrs. John L. Whitehurst Baltimore

Peter W. Chichester Frederick

Term Expires

. . 1949

. . 1952

. . 1953

. . 1952

. . 1954

. . 1951

. . 1948

. . 1959

. . 1950

. . 1951

. . 1956

. . 1957

Members of the Board are appointed by the Governor of the State for terms of
nine years each, beginning the first Monday in June.

The President of the University of Marj'^land is, by law, Executive Officer of the
Board.

A regular meeting of the Board is held the third Friday in each month, except
during the months of July and August.

Each school has its own Faculty Council, composed of the Dean and members
of its faculty; each Faculty CouncU controls the internal affairs of the group it
represents.

The University has the following educational organizations:

At Baltimore The College of Business and Public
The School of Dentistry Administration

The School of Law The CoUege ot Commerce

The School of Medicine The College ot Education

The School of Nursing The College of Engineering

The School of Pharmacv The College of Home Economics

The College of Education The Graduate School

(Baltimore Division) The Department of MiUtary

Science and Tactics

At College Park The Department of Physical
The College of x\gricultural Education and Recreation

The College of Arts and Sciences The Summer School

ADMINISTRATIVE OFFICERS

School of Medicine

H. C. Byrd, B.S., L.L.D., D.Sc President of the University

Maurice C. Pincoffs, B.S., M.D., Assistant to the President

H. Boyd Wylie, M.D Dean

O. G. Harne Assistant to the Dean

Alma H. Preinicert, M.A Registrar

Edgar F. Long, Ph.D Director of Admissions

s Resigned July 1, 1948.

THE SCHOOL OP MEDICINE, UNIVERSITY OF MARYLAND

FACULTY OF MEDICINE
EMERITI

J. Frank Crouch, M.D Professor of Clinical Ophthalmology and Otology, Emeritus

Harry Friedenwald, A.B., M.D.,D.H.L., D.Sc. .Professor of Ophthalmology, Emeritus

WnxiAM S. Gardner, M.D Professor of Gynecology, Emeritus^

J. M. H, Rowland, M.D., D.Sc, LL.D.

Professor of Obstetrics, Emeritus; Dean, Emeritus

J. Dawson Reeder, M.D Professor of Proctology, Emeritus

Henry J. Walton, M.D Professor of Roentgenology, Emeritus

Page Edmunds, M.D Professor of Traumatic Surgery, Emeritus

Ruth Lee Briscoe Librarian, Emeritus

Albertus Cotton, M.A., M.D. . . Professor of Orthopaedic Surgery, and Roentgenology,

Emeritus

Wiluam Tarun, M.D Professor of Ophthalmology, Emeritus'*

Joseph E. Gichner, M.D Professor of Clinical Medicine and Physical Therapeutics,

Emeritus

Harvey G. Beck, M.D., D.Sc Professor of Clinical Medicine, Emeritus

Irving J. Spear, M.D Professor of Neurology, Emeritus

COMPTON RiELY, M.D Clinical Professor of Orthopedic Surgery, Emeritus^'^

Carl L. Davis, M.D Professor of Anatomy, Emeritus

Arthur M. Shipley, M.D., D.Sc Professor of Surgery, Emeritus

FACULTY BOARD

Dean H. Boyd Wylie, Chairman
O. G. Harke, Secretary

WILLLA.M R. AmBERSON A. H. FiNKELSTEIN EdWARD A. LOOPER

Franklin B. Anderson Leon Freedom William S. Love, Jr.

James G. Arnold, Jr. Edgar B. Friedenwald John F. Lutz

Walter A. Baetjer Thomas K. Galvin Stanley H. Macht

Charles Bagley, Jr. Moses Gellman Howard J. Maldeis

J. Edmund Bradley Andrew C. Gillis Charles W. Maxson

Otto C. Brantigan Frank W. Hachtel Zachariah Morgan

Howard M. Bubert Harold E. Harrison Theodore H. Morrison

T. Nelson Carey Cyrus F. Horine Alfred T. Nelson

C. Jelleff Carr J. Mason Hundley, Jr, Emil Novak

Thomas R. Chambers Elliott H. Hutchtns Thomas R. O'Rourk

Carl Dame Clarke Edward S. Johnson Robert H. Oster

Ross McC. Chapman F- L. Jennings C. W. Peake

Paul W. Clough C. Lorlng Joslin D. J. Pessagno

Richard G. Coblentz Walter L. Kilby H. R. Peters

Beverley C. Compton Edward A. Kitlowski Maurice C. Pincoffs

„ -KT -Ti n,^^x, Vernon E. Krahl J. G. M. Reese

Charles N. Davidson ^ ^ ^ ^ ■'^

„ ^ John C. Krantz, Jr. Charles A.

Louis H. Douglass ; * at r- t.

Louis A. M. Krause Reifschneider

C. Reh) Edwards Kenneth D. Legge Dexter L. Reimann

Monte Edwards j, ^ locher Harjry M. Robinson, Sr.

Frank H. J. Figge q Carroll Lockaed Harry L. Rogers

5 Died Feb. 18, 1948.
5a Died Nov. 21, 1947.
6<i Died July 27, 1948.

FACULTY OP MEDICINE

MiuoN S. Sacks
Emil G. Schmidt
Dietrich C. Smith
R. Dale Smith
William H. Smith
Hugh R. Spencer
Thomas P. Sprunt

W. Houston Toulson
Ralph P. Truitt
Eduard Uhlenhuth
Henry F. Ullrich
Allen F. Voshell
John A. Wagner
Grant E. Ward
C. Gardner Warner

Huntington Williams
Walter D. Wise
Theodore E. Woodward
Thomas C. Wolff
Robert B. Wright
George H. Yeager
Waitman F. Zinn

EXECUTIVE COMMITTEE OF THE FACULTY

Dean H. Boyd Wylie, Chairman
O. G. Harne, Secretary

Louis H. Douglass
Charles Reid Edwards
Frank W. Hachtel

J. Mason Hundley, Jr.
FuTTT. G. Schmidt
T. Nelson Carey

Hugh R. Spencer

FACULTY OF MEDICINE

PROFESSORS

Myron S. Aisenberg, D.D.S., Professor of Pathology, School of Dentistry.

William R, Amberson, Ph.D., Professor of Physiology.

George M. Anderson, D.D.S., Professor of Orthodontics, School of Dentistry.

Thomas B. Aycock, B.S., M.D., Professor of Clinical Surgery .^'^

Charles Bagley, Jr., M.A., M.D,, Professor of Neurological Surgery.

Charles F. Blake, M.A., M.D., Professor of Proctology.^"

Otto C. Brantigan, B.S., M.D., Professor of Surgical Anatomy, Clinical Professor of

Surgery.
T. Nelson Carey, M.D., Professor of Clinical Medicine^ and Chairman of the Department

of Medicine.
Ross McC. Chapman, M.D., Professor of Psychiatry.
Clyde A. Clapp, M.D., Professor of Ophthalmology.'

Richard G. Coblentz, M.A., M.D,, Clinical Professor of Neurological Surgery,
Carl L. Davis, M.D., Professor of Anatomy.^

Brice M. Dorsey, D.D.S., Professor of Oral Surgery, School of Dentistry.
Louis H. Douglass, M.D., Professor of Obstetrics.
Frederick C. Dye, A.B., M.D., Professor of Anaesthesiology.^

It Is to be noted that for convenience of reference the names of the mem-
bers of the Faculty are listed in the forepart of this catalogue in alphabetical
order. The names are listed in order of seniority under each preclinical and
clinical department of the school on subsequent pages.

On the lists of the Faculty of Medicine and Fellows and the Hospital and Dispensary
staffs are given the names and positions assigned during the period July 1, 1947 to June 30,
1948 unless otherwise indicated. Changes are noted as follows:

^ Appointments effective July 1, 1948.

2 Promotions effective July 1, 1948.

' Resignations effective July 1, 1948.

^ On leave, effective July 1, 1948.

*» Resignation effective July 31, 1948.

6b Died Jan. 7, 1948.

5° Died Mar. 20, 1948.

7 Retired July 15, 1948.

10 THE SCHOOL OP MEDICINE, UNIVERSITY OP MARYLAND

Charles Reid Edwards, M.D., Professor of Surgery.

Monte Edwards, M.D., Clinical Professor of Surgery and Professor of Proctology;

Frank H. J. Figge, Ph.D., Professor of Experimental Anatomy.

H. K. Fleck, M.D., Clinical Professor of Ophthalmology.

Edgar B. Friedenwald, M.D., Professor of Clinical Pediatrics.

Thomas K. Galvin, M.D., Clinical Professor of Gynecology.

Grason W. Gaver, D.D.S., Professor of Dental Prosthetics, School of Dentistry.

Andrew C. Gillis, M.A., M.D., LL.D., Professor of Neurology.

Frank W. Hachtel, M.D., Professor of Bacteriology.

WilUam E. Ha.hn, A.B., M.S., D.D.S., Professor of Anatomy, School of Dentistry.

Harry C. Hull, M.D., Clinical Professor of Surgery.

J. Mason Hundley, Jr., M.A., M.D., Professor of G5mecology.

Elliott H. Hutchins, M.A., M.D., Professor of Surgery,

F. L. Jennings, M.D., Professor of Clinical Surgery.

C. Loring Joslin, M.D., Professor of Pediatrics.
Walter L. Kilby, M.D., Professor of Roentgenologj'.

Edward A. Kitlowski, A.B., M.D., Clinical Professor of Plastic Surgery.

John C. Krantz, Jr., Ph.D., D.Sc, Professor of Pharmacology.

Louis A. M. Krause, M.D., Professor of Clinical Medicine.

Kenneth D. Legge, M.D., Professor of CUnical Genito-Urinary Surgery.

G. Carroll Lockard, M.D., Professor of Clinical Medicine.

Edward A. Looper, M.D., D.Oph., Professor of Rhinology and Laryngology.
Theodore H. Morrison, M.D., Clinical Professor of Gastro-Enterology.
Ernest B. Nuttall, D.D.S., Professor of Crown and Bridge, School of Dentistry.
Thomas R. O'Rourk, M.D., Clinical Professor of Otology, Associate Professor of Rhinology

and Laryngology.
Robert H. Oster, Ph.D., Professor of Physiolog)^, School of Dentistry.

D. J. Pessagno, A.B., M.D., Professor of Clinical Surgery.

H. Raymond Peters, A.B., M.D., Professor of Clinical Medicine.

Maurice C. Pincoffs, B.S., M.D., Professor of Medicine.

Kennetli V. Randolph, D.D.S., Professor of Operative Dentistry, School of Dentistry.

Charles A. Reifschneider, M.D., Clinical Professor of Traumatic Surgery.

Harry L. Rogers, M.D., Clinical Professor of Orthopaedic Surgery.

Harry M. Robinson, Sr., M.D., Professor of Dermatology.

Emil G. Schmidt, Ph.D., LL.B., Professor of Biological Chemistry.^

Arthur M. Shipley, M.D., D.Sc, Professor of Surgery.^''

Hugh R. Spencer, M.D., Professor of Pathology.

Thomas P. Sprunt, A.B., M.D., Professor of Clinical Medicine.

W. Houston Toulson, M.Sc, M.D., Professor of Genito-Urinary Surgery.

Ralph P. Truitt, M.D., Professor of Clinical Psychiatry.

Eduard Uhlenhuth, Ph.D., Professor of Anatomy.

.\llen Fiske Voshell, A.B., M.D., Professor of Orthopaedic Surgery.

Huntington Williams, M.D., Dr. P.H., Professor o /Hygiene and Public Health.

Walter D. Wise, M.D., Professor of Surgery.

H. Boyd Wylie, M.D., Dean^* and Professor of Biological Chemistry.'

George H. Yeager, B.S., M.D., Clinical Professor of Surgery.

Waitman F. Zinn, M.D., Clinical Professor of Rhinology and Laryngology.

i« Appomted June IS, 1948.
^^ Resigned July 8, 1948.

FACULTY OF MEDICINE II

ASSOCIATE PROFESSORS

Franklin B. Anderson, M.D., Associate Professor of Rhinology and Laryngology, and
Otology.

James G. Arnold, Jr., M.D., Associate Professor of Neurological Surgery.

Walter A. Baetjer, A.B., M.D., Associate Professor of Medicine.

J. McFarland Bergland, B.S., M.D., Associate Professor of Obstetrics.^

J. Edmund Bradley, M.D., Associate Professor of Pediatrics.^

H. M. Bubert, M.D., Associate Professor of Medicine.

C. Jelleff Carr, Ph.D., Associate Professor of Pharmacology.

Thomas R. Chambers, A.B., M.D., Associate Professor of Surgery.

Carl Dame Clarke, M.A., Associate Professor of Art as Applied to Medicine.

Paul VV. Clough, B.S., M.D., Associate Professor of Medicine.

Charles N. Davidson, M.D., Associate Professor of Roentgenology.

Ross Davies, M.D., Associate Professor of Hygiene and Public Health.

Edward C. Dobbs, D.D.S., Associate Professor of Pharmacology, School of Dentistry.

J. S. Eastland, M.D., Associate Professor of Medicine.'

A. H. Finkelstein, M.D., Associate Professor of Pediatrics.^

Leon Freedom, M.D., Professor of Neurology, and Associate in Pathology.

Moses Gellman, B.S., M.D., Associate Professor of Orthopaedic Surgery.

O. G. Hame, Associate Professor of Histolog)', and Asst. to the Dean.

Harold E. Harrison, B.S., M.D., Associate Professor of Pediatrics.

Horace Hodes, M.D., Associate Professor of Hygiene and Public Health.

Cyrus F. Horine, M.D., Associate Professor of Surgery.

Albert Jaflfe, M.D., Associate Clinical Professor of Pediatrics.

Edward S. Johnson, M.D., Associate Professor of Surgery.

Vernon E. Krahl, B.S., M.S., Ph.D., Associate Professor of Gross Anatomy.

R. W. Locher, M.D., Associate Professor of Clinical Surgery.

William S. Love, Jr., A.B., M.D., Associate Professor of Medicine.

Howard J. Maldeis, M.D., Associate Professor of Legal Medicine and Associate in Path-
ology.

Charles W. Maxson, M.D., Associate Professor of Surgery.

James G. McAlpine, Ph.D., Associate Professor of Bacteriology.'

Walter C. Merkel, A.B., M.D., Associate Professor of Pathology.'

Samuel Morrison, A.B., IM.D., Associate Professor of Medicine^, Associate Professor of
Gastro-enterologj'i

H. Whitman Newell, M.D., Associate Professor of Psychiatry.

Emil Novak, A.B., M.D., D.Sc, Associate Professor of Obstetrics.

C. W. Peake, M.D., Associate Professor of Surgery.

J. G. M. Reese, M.D., Associate Professor of Obstetrics.

Benjanain S. Rich, A.B., M.D., Associate Professor of Rhinology and Laryngology,
Associate in Otology.

Milton S. Sacks, M.D., Associate Professor of Medicine^ and Head of Clinical Pathology,
Associate in Pathology

Dietrich Conrad Smith, Ph.D., Associate Professor of Physiology.

Frederick B. Smith, M.D., Associate Clinical Professor of Pediatrics.

William H. Smith, M.D., Associate Professor of Clinical Medicine.

Henry F. Ullrich, M.D., D.Sc, Associate Professor of Orthopaedic Surgery.

Grant E. Ward, A.B., M.D., Associate Professor of Surgery and Oral Surgery.

C. Gardner Warner, A.B., M.D., Associate Professor of Pathology.

12 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

William H. F. Warthen, A.B., M.D., Associate Professor of Hygiene & Public Health.
Glenn S. Weiland, Ph.D., Associate Professor of Biochemistry*
Thomas C. Wolff, M.D., Associate Professor of Medicine.^
Theodore E. Woodward, M.D., Associate Professor of Medicine^
Robert B. Wright, B.S., M.D., Associate Professor of Pathology.

ASSISTANT PROFESSORS

Thurston R. Adams, M.D., Assistant Professor of Surgery and Proctology.

Joseph C. Biddix, Jr., D.D.S., Assistant Professor of Clinical Operative Dentistry, School

of Dentistry.
H. F. Bongardt, M.D., Assistant Professor of Surgery.
Leo Brady, A.B., M.D., Assistant Professor of Gynecology.
Simon H. Brager, M.D., Assistant Professor of Surgery and Proctology.
Edward F. Cotter, M.D., Assistant Professor of Medicine, Associate in Neurology .^
J. G. N. Gushing, M.D., Assistant Professor of Psychiatry^
William W. Elgin, M.D., Assistant Professor of Psychiatry^
Francis A. EUis, A.B., M.D., Assistant Professor of Dermatology.
Maurice Feldman, M.D., Assistant Professor of Gastro-Enterology.
Wetherbee Fort, M.D., Assistant Professor of Medicine.
Frank J. Geraghty, M.D., Assistant Professor of Medicine.
Francis W. Gillis, M.D., Assistant Professor of Genito-Urinary Surgery.
Samuel S. Glick, M.D., Assistant Professor of Pediatrics.
Harry Goldsmith, M.D., Assistant Professor of Psychiatry.
Albert E. Goldstein, M.D., Assistant Professor of Pathology.
Henry F. Graff, A.B., M.D., Assistant Professor of Ophthalmology^
Hugh T. Hicks, D.D.S., Assistant Professor of Periodontology, School of Dentistry.
Harry K. Iwamota, Ph.D., Assistant Professor of Pharmacology.
H, Vernon Langeluttig, M.D., Assistant Professor of Medicine.'^
Philip L. Lemer, Assistant Professor of Neurology.
Hans W. Loewald, Assistant Professor of Psychiatry.
John F. Lutz, A.B., M.D., Assistant Professor of Histology.
Stanley H. Macht, B.S., M.D., Assistant Professor of Roentgenology.
Howard B. Mays, M.D., Assistant Professor of Genito-Urinary Surgerj^ and Instructor in

Pathology.
Zachariah Morgan, M.D., Assistant Professor of Gastro-EnterologJ^
Harry M. Murdock, B.S., M.D., Assistant Professor of Psychiatry.
George McLean, M.D., Assistant Professor of Medicine.
Alfred T. Nelson, M.D., Assistant Professor of Anaesthesiology.
James W. Nelson, M.D., Assistant Professor of Surgery.
M. Alexander Novey, A.B., M.D., Assistant Professor of Obstetrics.
Dexter L. Reimann, B.S., M.D., Assistant Professor of Pathology.
L O. Ridgely, M.S., M.D., Assistant Professor of Surgery.
Harry M. Robinson, Jr., B.S., M.D., Assistant Professor of Dermatology, Associate in

Medicine.
John E. Savage, B.S., M.D., Assistant Professor of Obstetrics.
Isadore A. Siegel, A.B., M.D., Assistant Professor of Obstetrics.
Edward P. Smith, M.D., Ph.G., Assistant Professor of Gynecology.
R. Dale Smith, Ph.D., Assistant Professor of Gross Anatomy.
Sol Smith, M.D., Assistant Professor of Medicine.

® Resigned February 1, 1948.

FACULTY OF MEDICINE 13

Lewis C. Toomey, D.D.S., Assistant Professor of Oral Surgery, School of Dentistry.^

J. Ridgeway Trimble, M.D., Assistant Professor of Surgery.

John A. Wagner, B.S., M.D., Assistant Professor of Pathology and Neuropathology

Assistant in Medicine.
Philip S. Wagner, M.D., Assistant Professor of Psychiatry.
W. Wallace Walker, M.D., Assistant Professor of Surgery and Surgical Anatomy.
Asa D. Young, M.D., Assistant Professor of Roentgenology.

ASSOCIATES

Conrad B. Acton, M.D., Associate in Medicine.
Marie A. Andersch, Ph.D., Associate in Medicine.
Margaret B. Ballard, M.D., Associate in Obstetrics.
Donald J. Bamett, M.D., Associate in Roentgenology.
Eugene S. Bereston, A.B., M.D., Associate in Dermatolog>^

Kenneth B. Boyd, A.B., M.D., Associate in Gynecologj' and Assistant in Obstetrics.
M. Paul Byerly, M.D., Associate in Medicine.
Beverley C. Compton, A.B., M.D., Associate in Gynecology.
Ernest I. Combrooks, A.B., M.D., Associate in Gynecologj'.^
W. A. H. Councill, M.D., Associate in Genito-Urinary Surgery.
Francis G. Dickey, M.D., Associate in Medicine.

D. McClelland Dixon, M.D., Associate in Obstetrics and Instructor in Pathology.
Everett S. Diggs, B.S., M.D., Associate in Gynecology .^
William K. Diehl, M.D., Associate in Gynecology .^
John C. Dumler, B.S., M.D., Associate in Gynecology.
J. J. Erwin, M.D., Associate in Gynecology.
Houston Everett, M.D., Associate in Gynecology.^
L. K. Fargo, M.D., Associate in Genito-Urinary Surgery.
William L. Fearing, M.D., Associate in Neurology.
Jerome Fineman, M.D., Associate in Pediatrics.^

Samuel L. Fox, M.D., Associate in Rhinology, Laryngology and Otology.
Irving Freeman, M.D., Associate in Medicine.
George Govatos, A.B., M.D., Associate in Surgery.
Raymond F. Helfrich, A.B., M.D., Associate in Surger>'.
W. Grafton Herspberger, M.D., Associate in Medicine.
John T. Hibbitts, M.D., Associate in Gynecology.
LesHe B. Hohman, M.D., Associate in Psychiatry^
John F. Hogan, M.D., Associate in Genito-Urinary Surgery.
Henry W. D. Holljes, M.D., Associate in Medicine^
Z. Vance Hooper, M.D., Associate in Gastro-Enterology.
Clewell HoweU, B.S., M.D., Associate in Pediatrics.
Meyer W. Jacobson, M.D., Associate in Medicine.
Joseph V. Jerardi, B.S., M.D., Associate in Surgery.
D. Frank Kaltreider, A.B., M.D., Associate in Obstetrics.
Arthur Karfgin, B.S., M.D., Associate in Medicine.
Fayne A. Kayser, M.D., Associate in Rhinology and Larjnigology.
Joseph I. Kemler, M.D., Associate in Ophthalmology.
F. Edwin Knowles, Jr., M.D., Associate in Ophthalmology.

Frederick T. Kyper, M.D., D.Sc, Associate in Rhinology, Lar>Tigology, and Broncho-
scopy, Instructor in Otology.
C. Edward Leach, M.D., Associate in Medicine.
Samuel Legum, M.D., .\ssociate in^Medicine.

14 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Ephraim T. Lisansk)', M.D., Associate in Medicine.

H. Edmund Levin, B.S., M.D., Associate in Bacteriology, Instructor in Medicine.^

G. Bowers Mansdorfer, B.S., M.D,, Associate in Pediatrics.

I. H. Maseritz, M.D., Associate in Orthopaedic Surgery.

Lyle J. Millan, M.D., Associate in Genito-Urinary Surgery.

Frank K. Morris, A.B., M.D., Associate in Gynecology, Instructor in Obstetrics.

W. Raymond McKcnzie, M.D., Associate in Rhinology and Lar3Tigology.

Hugh B. McNally, B.S., M.D., Associate in Obstetrics.

S. Edwin Muller, M.D., Associate in Medicine^

Herbert E. Reifschneider, A.B,, M.D., Associate in Surgery and Surgical Anatomy .^

Robert A. Reiter, M.D., Associate in Medicine.

Samuel T. R. Revell, M.D., Associate in Medicine.

William F. Rienhoff, Jr., M.D., Associate in Surgery.

Henry L. Rigdon, M.D., Associate in Surgery and Surgical Anatomy.^

R. C. V. Robinson, M.D., Associate in Dermatology^

Kathym L. Schultz, M.D., Associate in Psychiatry.

Theodore A. Schwartz, M.D., Associate in Rhinology and Laryngology.

William M. Seabold, A.B., M.D., Associate in Pediatrics.

Lawrence M. Serra, M.D., Associate in Medicine.

WiUiam B. Settle, M.D., Associate in Surgery, Instructor in Surgical Anatomy.

A. Albert Shapiro, B.S., M.D., Associate in Dermatology.*

Arthur G. Siwinski, A.B., M.D., Associate in Surgery.

Benedict Skitarelic, A.B., M.D., Associate in Pathology.

Henry A. Teitlebaum, B.S., M.D., Ph.D., Associate in Neurology'-

Isadore Tuerk, M.D., Associate in Psychiatry^

William K. Waller, M.D., Associate in Medicine.

Gibson J. Wells, M.D., Associate in Pediatrics.

Milton J. Wilder, M.D., Associate in Orthopaedic Surgery .*

Austin H. Wood, M.D., Associate in Genito-Urinary Surgery,

Israel Zeligman, A.B., M.D., Associate in Dermatology.

LECTURERS

Jonas Friedenwald, M.A., M.D., Lecturer in Ophthalmic Pathology.
Leonard Karel, Ph.D., Lecturer in Pharmacology.
Stephen Krop, Ph.D., Lecturer in Pharmacology.
Joseph M. Miller, M.D., Lecturer in Surgery.

INSTRUCTORS

A. Russell Anderson, M.D., Instructor in Psychiatry.

Leon Ashman, M.D., Instructor in Medicine.

Edmund G. Beacham, M.D., Instructor in Medicine.^

John Z. Bowers, B.S., M.D., Instructor in Medicine.

Harry C. Bowie, B.S., M.D., Instructor in Surgery and Surgical Anatomy.

Thomas S. Bowyer, A.B., M.D., Instructor in Gynecology and Assistant in Obstetrics.

George H. Brouillet, B.S., M.D., Instructor in Surgery, and Assistant in Surgical Anatomy.

Ann Virginia Brown, A.B., Instructor in Biological Chemistry.

Samuel H. Bryant, A.B., D.D.S., Instructor in Oral Diagnosis, School of Dentistry.

William J. Bryson, A.B., M.D., Instructor in Pathology*

Harold H. Bums, M.D., Instructor in Surgery.

FACULTY OP MEDICINE 15

Lucile J, Caldwell, M.D., Instructor in Dermatology.

Mary E. Chinn, A.B., Instructor in Physiology .^^

Richard J. Golfer, B.S., M.D., Instructor in Pathology

Joseph M. Cordi, M.D., Instructor in Pediatrics^

Stuart G. Goughlan, B.S., M.D., Instructor in Surgery.

John R. Davis, M.D., Instructor in Medicine.^

W. Allen Deckert, A.B., M.D., Instructor in Gynecology and Assistant in Surgery.

Martha C. Eaton, A.B., Sc.M., Instructor in Hygiene and Public Health.^

Ernest S. Edlow, A.B., M.D., Instructor in Gynecology.

Philip D. Flynn, M.D., Instructor in Medicine.

Paul N. Friedman, A.B., M.D., Instructor in Ophthalmology .^

WiUiam L. Garlick, A.B., M.D., Instructor in Surgery.

Jason H. Gaskel, M.D., Instructor in Orthopaedic Surgery.

Russell GigHotti, D.D.S., Instructor in Oral Diagnosis School of Dentistry .^

Samuel J. Hankin, M.D. Instructor in Medicine.

Alvin J. Hartz, A.B., M.D., Instructor in Medicine.

Mary L. Hayleck, M.D., Instructor in Pediatrics.

Robert F. Healy, M.D., Instructor in Surgery.

William G. HeKrich, B.S., M.D., Instructor in Medicine.

Benjamin Highstein, M.D., Instructor in Dermatology.

F. A. Holden, M.D., Instructor in Ophthalmology.*

Calvin Hyman, M.D., Instructor in Surgery.

Benjamin H. Isaacs, A.B., M.D., Instructor in Rhinology and Laryngology.

Edward S. Kallins, B.S., M.D., Instructor in Medicine.

William H. Kammer, Jr., A.B., M.D., Instructor in Medicine.

Clyde F. Kams, B.S., M.D., Instructor in Surgery.

A. Kremen, A.B., M.D., Instructor in Ophthalmology.

Louis J. KroU, A.B.. M.D., Instructor in Medicine.

Arnold F. Lavenstein, Instructor in Pediatrics.

Kurt Levy, M.D., Instructor in Medicine.

Joseph H. Marshall, M.D., Instructor in Psychiatry.

Henry J. Marriott, M.A., B.M., Instructor in Medicine.*

Karl F. Mech, B.S., M.D., Instructor in Gross Anatomy, and Pathology.

Israel P. Meranski, B.S., M.D., Instructor in Pediatrics.

J. Duer Moores, B.S., M.D., Instructor in Surger>'.

J. Huff ISIorrison, M.D., Instructor in Obstetrics.

S. Edwin Muller, M.D., Instructor in Medicine. ♦

Joseph E. Muse, Jr., B.S., M.D., Instructor in Medicine.

Ruth Musser, M.S., Instructor in Pharmacology.

John A. Myers, M.E.E., M.D., Instructor in Medicine, Assistant in Gastro-Enterology.

Francis J. McLaughlin, M.D., Instructor in Psychiatry.

Samuel Novey, M.D., Instructor in Psychiatry.

M. Paul Padget, M.D., Instructor in Medicine.

William A. Parr, M.D., Instructor in Otology.

Richard H. Pembroke, Jr., A.B., M.D., Instructor in Psychiatry.

Eugene L. Pessagno, A.B., D.D.S., Instructor in Operative Surgery, School of Dentistry.

Ross Z. Pierpont, M.D., Instructor in Surgical AnatomJ^2

Samuel E. Proctor, A.B., M.D., Instructor in Surgery.

Daniel R. Robinson, M.D., Instructor in Surgery.

Seymour W. Rubin, M.D., Instructor in Patholog>\

^ Resigned July 31, 1948.

16 TEE SCHOOL OF MEDICINE, UNIVERSITY OP MARYLAND

Clarence P. Scarborough, M.D., Instructor in Surgery .^

John F. Schaefer, B.S., M.D., Instructor in Su^ger3^

Robert C. Sheppard, M.D., Instructor in Surgery.

Albert J. Shochat, B.S., M.D., Instructor in G3,stro-Enterology.

Ruby A. Smith, B.S., M.D., Instructor in Ophthahnology.^

Cleo D. Stiles, M.D,, instructor in Ophthalmology.^

David Tenner, M.D., Instructor in Medicine.

Wilfred H. Townshend, Jr., A.B., M.D., Instructor in Medicine.

William D. VandeGrift, M.D., Instructor in Pathology.

Harold L. Vyner, M.D., Instructor in Psychiatry.

Frederick J. VoUmer, B.S., M.D., Instructor in Medicine.^

Daniel WUfson, Jr., A.B., M.D., Instructor in Medicine.

ASSISTANTS

Earnest E. Banfield, M.D., Assistant in Plastic Surgery .^

Robert E. Bauer, A.B., M.D., Assistant in Pathology .^

Harry McB. Beck, M.D., Assistant in Gynecology.

Robert Z. Berry, A.B., M.D., Assistant in Rhinology and Laryngology.

Frances M. Blackburn, Assistant in Art as Applied to Medicine.^

George H. BrouiUet, B.S., M.D., Assistant in Surgical Anatomy.^

Frances C. Brown, A.B., Assistant in Physiology.^*

Joseph G. Bird, A.B., M.D., Assistant in Pharmacology.

A. V. Buchness, A.B., M.D., Assistant in Surgery.

John W. Chambers, M.D., Assistant in Surgery, and Neurological Surgery.

Robert G. Chambers, M.D., Assistant in Surgery and Plastic Surgery.^

L. T. Chance, M.D., Assistant in Surgery.

Jerome Cohn, M.D., Assistant in Medicine.®

Jonas Cohen, M.D., Assistant in Medicine.^

Morris M. Cohen, M.D., Assistant in Dermatology .^

Donald D. Cooper, M.D., Assistant in Pediatrics.^

Samuel H. Culver, M.D., Assistant in Surgery.

Rajonond M. Cunningham, A.B., M.D., Assistant in Surgery, and Proctology.

Edwin O. Dane, Jr., B.S., M.D., Assistant in Surgery.^

E. Hollister Davis, A.B., M.D., Assistant in Anaesthesia.

George H. Davis, M.D., Assistant in Obstetrics.

John B. DeHoff, M.D., Assistant in Medicine.

William A. Dodd, M.D., Assistant in Gjmecology.

Charles H. Doeller, Jr., A.B., M.D., Assistant in Obstetrics and Gynecology.

WOliam C. Duffy, A.B., M.D., Assistant in G3mecology.

William C. Dunnigan, A.B., M.D., Assistant in Surgery.

Morris A. Fine, M.D., Assistant in Medicine and Genito-Urinary Surgery.

Donald E. Fisher, M.D., Assistant in Pathology.^

Audrey M. Fimk, A.B., Assistant in Medicine.

William H. Fustiag, M.D., Assistant in Medicine.^

L. Calvin Gareis, B.S., M.D., Assistant in Obstetrics.

William R. Geraghty, B.S., M.D., Assistant in Surgery.

® Appointed September 1st 1947.

^* Appointment effective September 1, 1948.

FACULTY OP MEDICINE 17

H. L. Granoff, A.B., M.D., Assistant in Gynecology.

Richard D. Grill, Assistant in Art as Applied to Medicine.

Joseph B. Gross, B.S., M.D., Assistant in Medicine.

John S. Haines, M.D., Assistant in Genito-Urinary Surgery.

Donald B. Hebb, M.D., Assistant in Surgery and Proctology.

John S. Haught, M.D., Assistant in Gynecology.

L. Ann Hellen, B.S., Assistant in Medicine.

Sylvia Himmelfarb, A.B., Assistant in Physiology.^*

John H. Hirschfeld, M.D., Assistant in Rhinology and Laryngology.

John V. Hopkins, M.D., Assistant in Orthopaedic Surgery.

Rollin C. Hudson, M.D., Assistant in Medicine.

Hugh Jewett, M.D., Assistant in Genito-Urinary Surgery.

Harry F. Kane, M.D., Assistant in GjTiecology.

James R. Kams, B.S., M.D., Assistant in Medicine, and Physician in charge of Medical

care of Students.^*
Schuyler G. Kohn, B.S., M.D., Assistant in Obstetrics.
Marvin Lacy, M.D., Assistant in Surgery and Plastic Surgery.^"
Alfred S. Lederman, Assistant in Gastro-Enterology.
Frank E. Leslie, A.B., M.D., Assistant in Medicine.
V. Harwood Link, A.B., M.D., Assistant in Dermatology.
F. Ford Loker, B.S., M.D., Assistant in Surgery.
Helen I. Maginnis, M.D., Assistant in Gynecology.
W. Kenneth Mansfield, Jr., M.D., Assistant in Obstetrics.
Charles B. Marek, M.D., Assistant in Gynecology.
Clarence W. Martin, M.D., Assistant in Obstetrics.^
WiUiam A. Mitchell, M.D., Assistant in Obstetrics.
Howard B. McElwain, M.D., Assistant in Surgery.
John C. Osborne, M.D., Assistant in Medicine.
Frank J. Otanasek, M.D., Assistant in Neurological Surgery.
Patrick C. Phelan, Jr., A.B., M.D., Assistant in Surgery.
Susan R. Pincoffs, R.N., Assistant in Medicine.^
Hazel Y. Pruitt, Assistant in Bacteriology.
Frederick M. Reese, A.B., M.D., Assistant in Ophthalmology.
James Russo, M.D., Assistant in Anaesthesiology.
William J. Rysanek, Jr., M.D., Assistant in Gynecology.
J. King B. E. Seegar, Jr., A.B., M.D., Assistant in Obstetrics.
Joseph C. Sheehan, B.S., M.D., Assistant in Gynecology.
E. Roderick Shipley, A.B., M.D., Assistant in Surgery.
Jerome Snyder, B.S., M.D., Assistant in Ophthalmology.'
Samuel Snyder, M.D., Assistant in Medicine.
O. Walter Spurrier, M.D., Assistant in Pediatrics.
Edwin H. Stewart, Jr., M.D., Assistant in Surgery.
Stuart D. Sunday, M.D., Assistant in Medicine.'-
William J. Supik, M.D., Assistant in Proctology.
Adam Swiss, M.D., Assistant in Medicine.^

Raymond K. Thompson, B.S., M.D., Assistant in Neurological Surgery.
T. J. Touhey, M.D., Assistant in Surgery.

^* Appointment effective August 1, 1948.
'"Appointment effective July 15; 1948.
•« Appointed August 1, 1948.

18 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

FACULTY OF MEDICINE

Robert B. Tunney, A.B., M.D., Assistant in Gynecology.
Stephen J. Van Lill, HI, A.B., M.D., Assistant in Medicine.
William Earl Weeks, M.D., Assistant in Pediatrics.
J. Carlton Wich, B.S., M.D., Assistant in Pediatrics.
Thomas L. Worsley, M.D., Assistant in Medicine.
Howard L. Zupnik, M.D., Assistant in Surgery.

FELLOWS

Jose A. Alvarez, M.D., Hitchcock Fellow in Neurological Surgery.^

Frederick K. Bell, Ph.D., U. S. Pharmacopoeia Fellow.

Joseph G. Bird, A.B., M.D., Fellow in Pharmacology.

George W. Bradford, M.D., Baltimore Rh Laboratory, FeUow in Medicine.*

William L. Byerly, Research Fellow in Surgery.^''

Robert G. Chambers, M.D., National Cancer Research Trainee.*

Robert M. H. Crosby, M.D., Fellow in Nevirological Surgery.

Elaine Gaby, A.B., Emerson Fellow in Pharmacology.

Joseph A. Guilbeau, Jr., M.D., Baltimore Rh Laboratory Fellow in Obstetrics.*

John B. Harman, B.S., Emerson Fellow in Pharmacology.*

C. Hal Ligram Research, Fellow in Surgery.*

Ra3Tnond F. Kline, B.S., M.S., Porter Fellow in Physiology.*

Marvin Lacy, M.D., National Cancer Research Trainee.*"

G. D. Maengwyn-Davies, Ph.M., Fellow in Pharmacologj'.*

John Shelby Metcalf, Weaver Fellow in Gross Anatomy.*

Edmund B. Middleton, Weaver Fellow in Gross Anatomy.*

Aaron Podolnick, B.S., M.D., Fellow in Psychiatry.*

Walter G. Reich, Jr., B.S., Weaver Fellow in Gross Anatomy.

Mary J. Sauerwald, A.B., Emerson FeUow in Pharmacology.

Edward B. Truitt, B.S., Markle Fellow in Pharmacology.

Edwin L. Seigman, A.B., M.D., FeUow in Roentgenology.

RESEARCH ASSISTANTS

Hans Ludes, Research Assistant in Physiology.'

John S. Metcalf, Jr., Research Assistant in Physiology.^*

UNIVERSITY HOSPITAL

EXECUTIVE COMMITTEE OF THE STAFF

Maurice C. Pincoffs, Assistant to the President)

H. Boyd Wylie, Dean, >Ex officio

Harold A. Sayles, Acting Superintendent, J

Charles F. Reifschneider, Chairman

Theodore E. Woodward, Secretary
Charles Reid Edwards Walter L. Kilby

T. Nelson Carey Alfred T. Nelson

J. Mason Htindley, Jr. Milton S. Sacks

Louis H. Douglass C. Lortng Joslin

George H. Yeager

Elected Members Term Expires Elected Members Term Expires

Richard Coblentz 1948 Howard B. Mays 1949

*" Appointment effective July 15, 1948. ^ Appointment effective July, 1948.

^a Appointment effective July and August 1948. ^'^ Appointment effective January 1, 1949.

UNIVERSITY HOSPITAL 19

Edwakd F. Cotter 1948 Samuel T. R. Revell, Jr 1950

Harry C. Hull 1949 Henry F. Ullrich 1950

UNIVERSITY HOSPITAL STAFF

Harold A. Sayles, Acting Superintendent
Physician-in-Chief Maurice C. Pincoffs

[Thomas P. Sprunt
j Louis A. M. Krause

Physicians ', G. Carroll Lockard

I William S. Love, Jr.
[T. Nelson Carey

Gastro-Enterologist Francis Dickey

f Irving J. Spear

Neurologists {

[Leon Freedom

[Ross McC. Chapman

Psychiatrists ^I Ralph P. Truttt

[h. WinTMAN Newell

fC. LORING JOSLIN

Albert Jaffe
Pediatricians \]. Edmund Bradley

A. H. FiNKELSTEIN

William M. Seabold

Dermatologist Harry M, Robinson, Sr.

. . , ^ _, ^ , . ^ [Francis h.. Ellis

Assistant Dermatologists i^^ , , -r. t

l^ Harry M. Robinson, Jr.

[Hugh R. Spencer

Pathologists \ Dexter L. Reimann

[John a. Wagner

Surgeon-in-Chief Chari^s Reid Edwards

[Charles Bagley, Jr.

Neurological Surgeons \ Richard G. Coblentz

[James G. Arnold, Jr.

[Edward A. Looper

Laryngolo gists i Franklin B. Anderson

[thomas R. O'Rourk

p f 1 • f / Monte Edwards

\Thurston R. Adams

[Allen Fisice Voshell

Orthopaedic Surgeons I Moses Gellman

[ Henry F. Ullrich

W. Houston Toulson

Genito-Urinary Surgeons

Dental Surgeon- in-Chief Brice M. Dorsey

W. A. H. COUNCILL
LyLE J. ISllLLAN

Howard B. Mays

THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Dentists .

Samuel H. Bryant

Edward C. Dobbs

Lewis C. Toomey

Eugene L. Pessagno

Russell Gigliotti

[Walter L. Kilby

Roentgenologists \ Charles N. Davidson

[Donald J. Barnett

Bronchoscopist Edward A. Looper

Associate Bronchoscopist Frederick T. Kyper

Assistant Bronchoscopist John H. Hirschfeld

Otologist Thomas R. O'Rourk

Anesthesiologist Alfred T. Nelson

Louis H. Douglass
J. G. M. Reese

Obstetricians i Isadore A. Sdegel

John E. Savage
^Hugh B. McNally
Ophthalmologists F. Edwtn Knowles, Jr.

I J. AIason Hundley, Jr.
Leo Brady
Beverly C. Compton
John C. Dumler
William K. Dlehl
Everett S. Diggs
Ernest I. Cornbrooks, Jr.
fj. Mason Hundley, Jr.
[Grant E. Ward
Physical Therapist Grace E. Shaw

Oncologists.

ANNUAL HOSPITAL APPOINTMENTS

The following annual appointments are made to the University Hospital:

Six Residents in Medicine Five Residents in Pediatrics

Twelve Residents in Surgery Three Residents in Roentgenology

Two Residents in Neurosurgery Twelve Rotating Junior Interns

Four Residents in Gynecology Twelve Rotating Senior^Intems

Six Residents in Obstetrics Two Straight Interns

Five Residents in Anaesthesiology One Dental Intern

UNIVERSITY HOSPITAL RESIDENT AND INTERN STAFF

July 1, 1948 to June 30, 1949

RESIDENT STAFF

Joseph W. Baggett, A.B., M.D., Assistant Resident in Gynecology
J. Marion Bankhead, B.S., M.D., Assistant Resident in Anesthesiology
Thomas G. Baristes, Jr., A.B., M.D., Assistant Resident in Surgery
Phillip R. Berger, B.A., B.S., Assistant Resident in Roentgenology
Charles V. Bowen, M.D., Assistant Resident in Obstetrics
William L. Byerly, B.S., M.D., Co-Resident in Surgery

UNIVERSITY HOSPITAL STAFF 21

RowELL C. Cloningee, A.B., M.D., Assistant Resident in Surgery

Etjgene C. Conner, M.D., Co-Resident in Anaesthesiology

R. Adams Cowi^ey, M.D., Assistant Resident in Surgery

RiCHAED J. Cross, B.S., M.D., Resident in Otorhinolaryngology and Ophthalmology

William C. Covey, M.D., Assistant Resident in Obstetrics

John Dennis, B.S., M.D., Assistant Resident in Roentgenology^

Miles E. Drake, B.S., M.S., Ph.D., M.D., Resident in Pediatrics

William C. Ebeung, III, B.S., M.D., Assistant Resident in Medicine

WiLLirOBD Eppes, B.S., M.D., Assistant Resident in Medicine

Joseph B. Ganey, A.B., M.D., Assistant Resident in Surgery

John F. Gayle, M.D., Resident in Gynecology

Benjamin M. Gold, B.S., M.D., Intern in Obstetrics

James H. Graves, B.S., M.D., Resident in Obstetrics

Frederick Go Kiatsu, M.D., Assistant Resident in Pediatrics

David B. Gray, M.D., Assistant Resident in Surgery

William B. Hagan, M.D., Assistant Resident in Surgery

Howard E. Hall, M.D., Assistant Resident in Medicine

John S. Haught, A.B., M.D., Assistant Resident in Obstetrics

Charles W. HLawkins, M.D., Resident in Urology

Richard D. Hoover, B.S., M.D., Assistant Resident in Medicine

Ann Howard, B.S., M.D., Assistant Resident in Pediatrics

Jerome Imburg, M.D., Assistant Resident in Pediatrics

C. Hal Ingram, A.B., M.D., Co-Resident in Surgery

Blackburn S. Joslin, M.D., Assistant Resident in Pediatrics

H. James Lambert, B.S., M.D., Assistant Resident in Surgery

LoRMAN L. Levinson, A.B., M.D., Assistant Resident in Obstetrics {assigned to Gynecology)

William D. Lynn, A.B., M.D., Assistant Resident in Surgery

James R. McNinch, Jr., A.B., M.D., Assistant Resident in Anaesthesiology

William H. Mosberg, B.S., M.D., Resident in Neurosurgery

William T. Raby, B.S., M.B., M.D., Resident in Medicine

James J. Range, A.B., M.D., Resident in Roentgenology^

Edwin L. Seigman, A.B., M.D., Fellow in Roentgenology

Cecil Shaeer, B.S., M.D., Co-Resident in Anaesthesiology

James H. Shell, M.D., Assistant Resident in Gynecology {assigned to Obstetrics)

George W. Smith, M.D., Assistant Resident in Neurosurgery

Robert L. Stone, A.B., M.D., Assistant Resident in Gynecology^

Paul Tinker, B.S., M.D., Assistant Resident in Gynecology*'

David R. Will, M.D., Assistant Resident in Surgery

James R. Wlnterringer, M.D., Assistant Resident in Obstetrics

Isaac C. Weight, B.S., M.D., Assistant Resident in Medicine

SENIOR INTERNS

John F. Benson, B.S., M.D. Robert C. Hunter, B.S., M.D.

Frank E. Brumback, M.D. Arlie R. Mansberger, Jr., M.D.

John E. Evans, Jr., B.S., M.D. John B. Piggott, Jr., B.S., M.D.

William A. Gakenheimer, M.D. John H. Rosser, B.S., M.D.

Robert R. Hahn, M.D. Joseph Shear, B.S., M.D.

John A. Hightower, M.D. John P. White, HI M.D.

1 Until October 31, 1948— Resident thereafter.

2 Until October 31, 1948.

3 Until March 31, 1949.

^ April, May, and June 1949.

THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

JUNIOR INTERNS

David Atjld, A.B., M.D.
James M. Bisanar, M.D.
John R. ILAisrEiNS, B.A., M.D.
Frederick J. Heldiuch, Jr., M.D.
William J. Holloway, M.D.
H. Patterson Mack, M.D.

Nicholas Mallis, M.D.
Fred R. McCruitb, Jr., M.D.
William; A. Niermann, M.D.
Phyllis Ann Petersen, A.B., M.D.
Kyle L. Swisher, Jr., M.D.
Frank J. Theuerkaup, Jr., M.D.

DENTAL INTERN
Charles W. DeVier, Jr., D.D.S.

UNIVERSITY HOSPITAL DISPENSARY STAFF

Emma Wmsmp, R.N.

Dispensary Director

DISPENSARY COMMITTEE

George H. Yeager, Chairman

Emma Winship, R.N., Secretary

Allen Fiske Voshell
Beverley C. Compton
A. H. Finkelstein

Lewis P. Gundry
Howard B. Mays
J. Huff Morrison

Chief of Medical Clinics Le^is P. Gundry^

L. A. M. KJELAUSE

T. Nelson Carey
Milton S. Sacks
Frank J. Geraghty
Edward F. Cotter
Conrad B. Acton
Irving Freeman
M. Paul Byerly
William K. Waller

E. T. LiS.ANSKY

Samuel T. R. Revell
Arthur Karfgin
Kurt Levy

Physicians s Leon Ashman

Joseph E. Muse, Jr.
Samuel J. Hankin
Morris Fine
Joseph B. Gross
James R. Karns
Franklin E. Leslie
John B. DeHoff
Thomas H. Magness
Elizabeth D. Sherrill
Charles H. Williams
HAR\rEY L. Fuller
Jonas Cohen

Chief of Gastro-Enterology Clinic Francis G. Dickey

3 Resigned — effective Juty 1, 1948.

UNIVERSITY HOSPITAL DISPENSARY STAFF

Assisiant Cardiologists .

jZ. Vance Hooper

Assistant Gastro-Enterolo gists \ Albert J. Shochat

[Axfred S. Lederman

Chief of Neurology Clinic Leon Freedom

[WrLiiAM L. Fearing

Assistant Neurologists s Harry A. Teitelbaum

[Edward F. Cotter

Chief of Psychiatric Clinic Ralph P. Trxjitt

Clinic Director H. Whitman Newell

Hans W. Loewald

. . , , „ , . . . . Kathryn L. Schultz

Assistant Psycmatnsts < _ ^^

■^ Richard Pembroke

[Aaron Podolnik

Chief of CJtest Clinic Meyer D. Jacobson

Assistant, Diseases of the Lungs Manuel Levin

Chief of Metabolism Clinic W. Graeton Hersperger

Assistant in Metabolism Clinic Louis V. Blum

Chief of Cardiovascular Clinic C. Edward Leach

WiLDRED H. TOWNSHEND

William G. Helfrich
RoLLiN C. Hudson
Stephen J. van Lill, IH

Chief of Allergy Clinic H. M. Bubert

Assistant Chief of AUergy Clinic Edward S. Kallins

Jesse S. Fieer
Salah a. Tawab
J. Carlton Wich
Irvin Bern.^rd Kemick
Ross C. Brooks

Allergy Clinic Dietician Joyce Weston

JSelma R. Goldsmith
■\ Shirley W. Correl

Director, Pediatric Clinic A. H. Finkelstein

Chief of Pediatric Clinic Samuel S. Glick

Louis V. Blum
Arnold F. Lavenstein
Thom.\s E. Weeks
J. Carlton Wich
Ramsay B. Thomas
Howard Goodman
Melvin N. Borden
Lester Caplan
Israel P. Meranski
Gibson J. Wells
Ruth B. Baldwin

Chief of Endocrinology Clinic Conrad B. Acton

Chief of Surgical Clinic Robert C. Shkppard

Assistant Allergists.

Allergy Clinic Technicians .

Assistant Pediatricians .

THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Assistant Dermatologists aiid Syphilologists .

Assistant Surgeons.

Assistant Orthopedic Surgeons.

Director of Dermatology and Syphilis Clinic Harry M. Robinson, Sr.

Chief of Dermatology a^td Syphilis Clinic Harry M. Robinson, Jr.

Dermatologists and Syphilologists Sp _^

Francis A. Ellis
Eugene S. Bereston
A. Albert Shapiro
Lester N. Kolman
Benjamin Highstein
LucnE Caldwell
V. Harwood Link
Morris M. Cohen
Mare B. Hollander
I Alpred H. Dann
E. Roderick Shipley
Samuel E. Proctor
William B. Settle
Karl F. Mech

Chief of Plastic Surgery Clinic Clarence P. Scarborough

Chief of OrtJtopedic Surgery Clinic Allen Fiske Voshell

Moses Gellman
Henry F. Ullrich
Milton J. Wilder
S. M. Thompson
Robert B. Mearns

Chief of Genito-Urinary Clinic W. Houston Toulson

w. a. h. councill
John F. Hogan

LyLE J. MiLLAN

Morris A. Fine
Howard B. Mays

Chief of Rhinology and Laryngology Clinic Benjamin S. Rich

[Thomas R. O'Rouek

Assistant Rhinologists and Laryngolo gists < Samuel L. Fox

[Albert Steiner

Chief of Proctology Clinic Monte Edwards

[Thurston R. Adams
Donald B. Hebb
I William J. Supik
[Raymond Cunningham

Chief of Gynecology Clinic J. Mason Hundley, Jr.

Assistant Chief of Gynecology Clinic Beverley C. Compton

John C. Dumler
William K. Diehl
Everett S. Diggs
Ernest I. Cornbrooks, Jr.
John T. Hibbitts
Kenneth B. Boyd
W. Allen Deckert
Helen I. Maginnis
Charles B. Marek
Stuart Rizika
William A. Mitchell
Theodore Kardash

Assistant Genito-Urinary Surgeons.

Assistant Proctologists.

Assistant Gynecologists.

UNIVERSITY HOSPITAL DISPENSARY STAFF

Female Cystoscopists.

Assistant Dentists.

Assistant Obstetricians .

I J. Mason Hundley, Jr.
1 Beverley C. Cohpton
Willla:m: K. Deehl
Ernest I. Cornbrooks, Jr.
Everett S. Diggs

Chief of Dental Clinic Brice M. Dorsey

Assistant Chief of Dental Clinic Lewis C. Toomey

Russell Gigliotti
Samxtel H. Bryant
Edwakd C. Dobbs
Eugene L. Pessagno

Chief of Obstetrical Clinic J. Hutf Morrison

Assistant Chief of Obstetrical Clinic Margaret B. Ballard

Hugh B. McNally
D. McClelland
D. Frank Kaltreider
W. Kenneth Mansfield, Jr.
L. Calvin Gareis
William A. Mitchell
J. K. B. E. Seegak
Kjenneth B. Boyd
Clarence W. Martin
J. Mason Hundley, Jr.
Beverley C. Compton
John C. Dumler
William K. Diehl
Ernest I. Cornbrooks, Jr.
Everett S. Diggs
[Grant E. Ward
i j. duer moores
I Arthur G. Siwinski
[Edwin H. Stewart, Jr.

Chief of Vascular Clinic George H. Yeager

Assistant Chief of Vascular Clinic George H. BROxnLLET

Medical Consultant-Vascular Clinic Lewis P. Gundry

Chief of Ophthalmology Clinic F. Edwin Knowles, Jr.

[Paul N. Friedman
I Cleo D. Stiles
1 Ruby Smith
^Frederick M. Reese

Directress, Occupational Therapy Miss Lora E. Dunetz

Directress, Physical Therapy Mrs. Dorothy Hardie

Directress, Social Service Miss Mary Fitzpatrick

Oncology Clinic, Gynecological Division.

Oncology Clinic, Surgical Division .

Assistant Ophthalmologists .

MEDICAL CARE CLINIC

Director Henry W. D. Holljes

Assistant Director Susan R. Pincoffs

Statistical Consultant Marth.\ C. Eaton

The Medical Care Clinic of the University of Maryland is the result of a study
by the Medical and Chirurgical Faculty of Maryland in cooperation with the

26 THE SCHOOL OP MEDICINE, UNIVERSITY OF MARYLAND

State Planning Commission. The present Clinic, located on the third floor of
the Dispensary Building, is the first of its kind in this country. Public assistance
clients are referred to the Clinic by the Baltimore City Health Department and
are scheduled for an initial physical examination by physicians affiliated with the
University of Maryland. A family physician is chosen by the patient from a list
available at the Clinic. Copies of the individual's medical history and examina-
tions are sent to the physician selected, who then becomes responsible for the
medical care of the patient.

The Medical Care Program is, in this way, an entirely new approach to the
problem of the indigent patient. For the first time, he becomes the responsibility
of a private physician. This places the practice of medicine to the indigent on a
par with the practice of private medicine.

After the initial examination, the Clinic functions as a diagnostic center to
serve the needs of the neighborhood practitioner. Consultants working in the
Medical Care Clinic are available and at present represent Medicine, Surgery,
Gynecology and Otolaryngology. Others wiU be added as required.

The Clinic functions between 8:30 and 4:30 daily. Registrations and referrals
are conducted in the morning. Clinical examinations and consultations are held
during the afternoon. Approximately fifty neighborhood physicians have agreed
to work with the Medical Care Program. Twenty-five members of the Out-pa-
tient Department and University Hospital Staff will conduct examinations in the
Clinic.

The Faculty Committee on Post Graduate Education has also undertaken plans
to provide instruction to all affiliated physicians.

Four thousand public assistance clients have been assigned to this Clinic.

DISPENSARY REPORT FOR YEAR BEGINNING

JULY 1, 1946 AND ENDING JUNE 30, 1947

Departments New Cases Old Cases Total

Allergy 148 3,767 3,915

Cardiology 155 1,292 1,447

Cystoscopy ' 80 333 413

Dermatology 5,593 10,565 16, 158

Diabetic 89 748 837

Ear, Nose and Throat 1,217 1,446 2,663

Endocrine 93 163 256

Eye 1,076 3,034 4,110

Gastro-Intestinal 197 865 1,062

Gemto-Urinary 437 781 1,218

Gynecology 1,664 5,215 6,879

Hematology 5 103 108

Medicine 1,745 3,677 5,422

Neurology 191 540 731

MERCY HOSPITAL STAFF

Neuro-Surgery 204

Obstetrics 2,214

Occupational Therapy 67

Oncology 187

Oral Surgery 140

Orthopedic 1,423

Pediatric 1,514

Physiotherapy 130

Plastic Surgery 24

Proctology 188

Psychiatry 336

Surgery 3,230

Tuberculosis 124

Vascular 91

Total 22,562

238

442

15,810

18,024

426

493

1,022

1,209

139

279

3,061

4,484

6,590

8,104

846

976

252

440

465

801

6,304

9,534

579

703

378

469

68,652

91,214

Mother M. Beknadette
Sister M. Veronica
Sister M. Carmel
Sister M. Cornelia
Sister M. Vincent
Sister M. Damian

MERCY HOSPITAL
BOARD OF GOVERNORS

Wali-er D. Wise, Chairman

Elliott H. Hutchins

MERCY HOSPITAL STAFF

Henry F. Bong^vrdt

H. Raymond Peters

Maurice C. Pincoits

WaiTMAN F. ZlNN

Thomas K. Galvin
Edward P. Smith

Stirgeon-in-Chief .

Surgeons.

Neurological Surgeons .

Walter D. Wise
Elliott H. Hutchins
F, L. Jennings
r. w. locher
Thomas R. Chambers
D. J. Pessagno
William F. Rienhoff
Henry F. Bongardt
Charles Bagley, Jr.
Richard B. Coblentz
James D. Arnold, Jr.
Frank J. Otenasek
John W. Chambers
Raymond K. Thompson

THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Associate Surgeons .

Assistant Surgeons .

Plastic Surgeon

Consulting Ophthalmologist and Otologist .
Ophthalmologists and Otologists

Associate Ophthalmologists and Otologists.
Assistant Ophthalmologists and Otologists.

Consulting Rhinologists and Laryngologists .
Rhinologist and Laryngologist

Associste Rhinologists and Laryngologists .

Assistant Rhinologist and Laryngologist. .

BroncJioscopist

Associate Bronchoscopist

Assistant Bronchoscopist

Consulting Orthopaedic Surgeon

Orthopaedic Surgeon

[l. O. RiDGELY

James V/. Nelson
HowAio) B. McElwatn
I SmoN H. Bragee
John A. O'Connor
Chaio^s W. Maxson

I. RiDGEWAY TeIMBLE

Raymond F. Helfrich
Julius Goodman
S. Demarco, Jr.
T. J. Touhey
William N. McFaul, Jr.
Meyer H. Zdravin
Howard L. Zurnik
Daniel R. Robinson
Joseph V. Jerardi
Wm. C. Dunnigan
Harold H. Burns
William L. Garxick
John F. Schaeffer
F. Ford Loker
Patrick C. Phelan

fEDWARD A. KrCLOWSKI

\ Clarence P. Scarborough

Harry Friedenwald

H. K. Fleck
M. Raskin

Joseph I. Kemler
F. A. Pacienza

Joseph V. Jeppi

F. Edwin Knowles, Jr.

W. Raymond McKenzie
George W. Mitchell

Waitman F. Zinn

Fayne a. Kayser
Benjamin S. Rich
Theodore A. Schwartz

BiRKHEAD MaCGOWAN

Benjamin H. Isaacs
Joseph V. Jeppi
Waitman F. Zinn
Fayne A. Kayser
Theodore A. Schwartz
Albertus C. Cotton
H. L. Rogers

MERCY HOSPITAL STAFF

Assistant Orthopaedic Surgeons.

Associate Urologists.

Associate Orthopaedic Surgeon Henry F. Ullrich

fl. H. Maseritz
[J. H. Gaskel

Urologist Kenneth D. Legge

JLeon K. Fargo
'\ Francis W. Gillis

[Francis A. Ellis
A William D. Wolfe*
[Eugene S. Bereston

Dermatologists .

Dentist

Consulting Dentist. . .
Consulting Physician .
Physician4n-Chief . . .

Physicians .

Associate Physicians.

]. D. Fusco

Conrad L. Inman

Maurice C. Pincofes

H. Raymond Peters

Harvey G. Beck
Thomas P. Sprunt
George McLean
J. Sheldon Eastland
Louis A. M. Krause
Thomas C. Wolff

Hubert C. Knapp
Bartus T. Baggott
Wetherbee Fort
•iJOHN E. Legge
T. Nelson Carey
Sol Smith
Hugh J. Welch

S. A. Tumminello
J. Howard Burns
Earl L. Chambers

K. W. GOLLEY

William H. Kammer
S. Edwin Muller
John R. Davis, Jr.
J. Emmett Queen
Frederick J. Vollmer
John C. Osborne

[R. Frederick Leitz
\ Theodore H. Morrison
(Maurice Feldman

Philip D. Flynn

f Edgar B. Friedenwald
\ Frederick B. Smith

Associate Pediatrician G. Bowers Mansdorper

Assistant Physicians.

Associate Gastro-Enterologisls .

Assistant Gastro-Enterologist . .
Pediatricians

6 Died June 29, 1948.

TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Assistant Pediatricians.

WnxiAM M. Seabold
Jerome Fineman
O. Walter Spurrier
Israel P. Meranski
Edward L. Frey, Jr.

Neurologist and Psychiairisi Andrew C. Gillis

Associate Neurologists and Psychiatrists

j Harry Goldsmith
[Philip F. Lerner

Obstetrician-in-Chief Edward P. Smtxh

[j. J. Erwin

I Thomas K. Galvin

Obstetricians \ Frank K. Morris

Ernest S. Edlow
Hugh B. McNally

Associate Obstetricians.

Assistant Obstetricians .

Gynecologist-in-Chief . .
Gynecologists

Associate Gynecologists.

Assistant Gynecologists .

Pathologists .

Clinical Pathologist .
Clinical Biochemist .

fWiLLiAM C. Duffy

\ Charles H. Doeller, Jr.

J. Howard Burns
Harry F. Kane
William A. Dodd
Harry McB. Beck
Joseph C. Sheehan
William J. Rysanek, Jr.
Robert B. Tunney

. Thomas K. Galvin

[Edward P. Smith
A J. J. Erwin
[Frank K. Morris

f Ernest S. Edlow
, I George A. Strauss, Jr.
[h. L. Granoff

Charles H. Doeller, Jr.
William A. Dodd
Harry McB. Beck
William C. Duffy
Joseph C. Sheehan
William J. Rysanek, Jr.
Harry F. Kane
Robert B. Tunney

TWalter C. Merkel
\Hugh R. Spencer

. H. T. Collenberg

, Charles E. Brambel

Technicians

Technicians.

MERCY HOSPITAL STAFF 31

Sister Paula Marie
Eleanor Behr
Charlotte Schwalm
Lillian Marie Lawler
Elizabeth Johnson
Carmela E. Miceli

Consulting Radiologist Albertus Cotton

Radiologist Asa D. Young

Assistant Radiologist E. Eugene Covington

Sister Paula Marie
Eleanor Behr
Elizabeth Johnson
Carmela E. Miceli
Llllian Butler
Betty Wolfram
Virginia Schwarz
Julietta Perez
Technician (X-ray) Ruth L. Gephardt

ANNUAL HOSPITAL APPOINTMENTS

The following annual appointments are made to the Mercy Hospital:

Five Residents in Surgery Resident in Pathology

Four Residents in Medicine Resident in Rhinology

Three Residents in Gynecology and Obstetrics
Twelve Interns on Rotating Service

MERCY HOSPITAL RESIDENT AND INTERN STAFF

JULY 1, 1948-JUNE 30, 1949

RESIDENT STAFF

William D. McClung, M.D., Resident Surgeon

James G. Stegmaier, B.S., M.D., Associate Resident Surgeon

D. Otis Montgomery, A.B., M.D., Assistant Resident Surgeon

Elden H. Pertz, B.S., M.D., Assistant Resident Surgeon

Joseph D. Reahl, A.B., M.D., Assistant Resident Surgeon

Richard E. Hunter, A.B., M.D., Resident Gynecologist

John F. Ullsperger, A.B., M.D., Resident Obstetrician

Claude F. Bailey, A.B., M.D., Assistant Resident Gynecologist & Obstetrician

Vincent dePaul Fitzpatrick, A.B., M.D., Assistant Resident Gynecologist & Obstetrician

Joseph J. Bowen, B.S., M.D., Resident Physician

Henry V. Chase, B.S., M.D., Assistant Resident Physician

Joseph F. LiPira, B.S., M.D., Assistant Resident Physician

Edgar W. Young, A.B., M.D., Assistant Resident Physician

A. Maynard Bacon, Jr., B.S., M.D., Pediatric Resident

Arthur J. Linden, B.S., M.D., Resident Otolaryngologist

THE SCHOOL OP MEDICINE, UNIVERSITY OF MARYLAND

INTERNS

Joseph L. Aponte, M.D.
John M. Buchness, A.B., M.D.
Robert E. Ensor, M.D.
John A. Ferris, B.S., M.D.
AixYN F. JnDD, A.B., M.D.

Albert M. Powell, Jr., M.D.
John R. Shell, M.D.
Thaddeus C. Siwinski, A.B., M.D.
Rennert M. Sicelser, M.D.
Clyde D. Thomas, Jr., M.D.

MERCY HOSPITAL DISPENSARY STAFF

Dispensary Director

Supervisor of Surgical Clinic .

Dispensary Surgeons.

Sister M. Agnesine

Harold H. Burns

I. RiDGWAY Trimble
Simon H. Brager
Howard L. Zupnik
Daniel R. Robinson
Joseph V. Jerardi
William C. Dunnigan
William L. Garlick
John F. Schaeeer
F. Ford Loker
Patrick C. Phelan
Arthur G. Siwinski
Melvin F. Polek
Clarence P. Scarborough

Supervisor of Geniio-Urinary Clinic Kenneth D. Legge

fL. K. Fargo

Assistant Genito-Urinary Surgeons sFrancis W. Gn.T.TS

[John S. Haines

Supervisor of Orthopaedic Clinic Harry L. Rogers

f Henry F. Ullrich

. 1 ISA.\C GUTMAN

Orthopaedzc Surgeons I. H. Maseritz

[Jason H. Gaskel

Supervisor of Medical Clinic H. Raymond Peters

Sol Smith
, S. Edwin Muller

Chiefs of Medical Clinic.

Assistant Physicians.

Frederick J. Vollmer
William H. Kammer
John R. Davis
J. Emmett Queen
Charles F. O'Donnell
Arthur Karegin
John C. Osborne

Chief of Allergy Clinic S. Edwin Muller

Chief of Cardiovascular Clinic Thomas C. Wolff

Assistant Cardiologist Leon Ashman

MERCY HOSPITAL DISPENSARY STAFF

Pediatricians.

Chief of Metabolism Clinic J. Sheldon Eastland

Assistant in Metabolism Clinic J- E. Qtxeen

Gastro-Enterologist Maurice Feldman

Assistant Gastro-Enterologist Philip Flynn

Chief of Pediatric Clinic Edgar B. Feiedenwald

Jerome Fineman

Israel T. Meranski

O. Walter Spurrier

j Edward L. Frey, Sr.

J. Carlton Wich

Donald Cooper

Earl Weeks

Joseph Coedi

. Andrew C. Gillis

fPHTLrp F. Lerner

■ \Henry J. Marriott

Supervisor of Dermatology Clinic Francis A. Ellis

„ , . , TEugene S. Bereston

Dermatolog^sts \r. C. V. Robinson

Oncologist James W. Nelson

Chief of Gynecology Clinic Thomas K. Galvin

Edward P. Smith
J. J. ERwm
Frank K. Morris
Ernest S. Edlow
Charles H. Doeller, Jr.
Gynecologists \ William A. Dodd

Supervisor of Neurological and Psychiatric Clinic.
Neurologists and Psychiatrists

Harry McB. Beck
William C, Dueey
Joseph C. Sheehan
Harry F. Kane
Robert B. Tunney

Chief of Obstetrical Clinic Edward P. Smith

Harry F. Kane
Charles H. Doeller, Jr.
William A. Dodd

C^stetricians { Harry McB. Beck

William C. Duffy
Joseph C. Sheehan
Robert B. Tunney

Esophagoscopist Waitman F. Zestn

Associate Esophagoscopist Fayne A. Kayser

Waitman F. Zinn

„,.,., , , , . , .Theodore A. Schwartz

Rhmologists and Laryngologtsts \j, „ ,

Arthur Ward

34 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

(M. Raskin
F, A. Pacienza
Joseph V. Jeppi

Proctologist Simon H. Brager

Supervisor oj Dental Clinic J. D. Fusco

Consulting Dentist Conrad L. Inman

Supervisor of Physiotherapy Clinic Leon Hannan

Assistant Physiotherapist Alice R. Hannan

_ . , TT7- 7 f Sister M. Vencent

Social Workers <. „

[Anna Shawbaker

Secretary Eva Applegarth

MERCY HOSPITAL DISPENSARY REPORT

Year of 1947

Department New Cases

Allergy 9

Bronchoscopic 366

Cardiology 18

Dental 78

Dermatology 242

Diabetic 21

Gastro-Intestinal 30

Genito-Urinary 69

Gynecology 254

Medicine 621

Neurology 56

Ophthalmology 215

Orthopaedics 85

Pediatrics 364

Physiotherapy 135

Plastic Surgery 1

Postnatal 198

Prenatal 313

Proctology 23

Rhinolaryngology 400

Surgery 976

Surgical FoUow-Up 159

Well Baby Clinic 38

Totals 4,662 16,543 21,214

Old Cases

Total

629

995

156

174

117

195

683

925

388

409

123

500

569

615

869

2,920

3,541

313

369

432

647

260

345

876

1,240

1,785

1,920

198

2,263

2,576

667

1,067

3,069

4,045

358

517

THE BALTIMORE CITY HOSPITALS STAFF 35

THE BALTIMORE CITY HOSPITALS

STAFF, 1948-1949
Parker J. McMillin, Superintendent

Surgeon-in-Chief Otto C. Beantigan, M.D.

Physician-in-Chief, Acting C. Holmes Boyd, M.D.

Physician-in-Chief, Radiology Stanley H. Macht, B.S., M.D.

Physician-in-Chief, Tuberculosis Hospital H. Vernon Langeluttig, M.D.

Assistant Physician-in-Chief, Tuberculosis Hospital Editund C. Beacham, M.D-

Obstetrician-in-Chief Louis H. Douglass, M.D.

Pediatrician-in-Chief Harold E. Harrison, B.S., M.D.

Pathologist-in-Chief C. Gardner Warner, A.B., M.D.

Dental Surgeon-in-Chief Lowell P. Henneberger, D.D.S.

Dental Surgeon-in-Chief, Acting H. Glenn Waring, D.D.S.

Consultant in Psychiatry Esther L. Richards, M.D.

James C. Owings, M.D.

Visiting Surgeons .

II. RiDGEWAY Trimble, M.D.

I Amos Koontz, M.D.

Thurston R. Adams, M.D.

Consultant in Traumatic Surgery Charles A. Reifschneider, M.D.

Consultant in Peripheral Vascular Diseases George H. Yeager, B.S., M.D.

,. . . T,, J- r, f Edward A. Kitlowski, M.D.

Consultants tn Plastic Surgery <_ T.;r tt t t»t t^

* -^ [Edward M. Hanrahan, Jr., M.D.

Assistant Visiting Plastic Surgeon Clarence P. Scarborough, M.D.

[Harry C. Bowie, M.D.
Assistant Visiting Surgeons i Donald B. Hebb, M.D.

[Henry L. Rigdon, M.D.

Assistant Visiting Physician, Ttibercvlosis John H. Hirschfeld, M.D.

Visiting Obstetrician J. Morris Reese

D. Frank Kalteeider, M.D,
John E. Savage, M.D.

Assistant Visiting Obstetricians I' ^^ ^ \r ^

^ W. Newton Long, M.D.

George W. Anderson, M.D.

L. Calvin Gareis, M.D.

Assistant Pediatrician-in-Chief Robert E. Thoenfeldt, M.D.

Visiting Pediatrician Hans Bix, M.D.

J. Mason Hundley, Jr., M.D.

Visiting Gynecologists '

Beverley Compton, M.D.
John C. Dumler, M.D.
John T. Hibbits, M.D.

A •. . Tr- -J- ^ ... [Ernest I. Cornbrooks, M.D.

Assistant Visiting Gynecologists < „, „ -^ . , ^

^ -^ ^ [William K. Diehl, M.D.

36 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Assistant Chief Physician Howard K. Rathbun, M.D.

(Loms A. M, Krause, M.D.
Charles W. Judd, M.D.
William G. Speed III, M.D.
Crawtord N. Kirkpatrick, M.D.
(Dean F. Davies, M.D.
Robert M. Paine, M.D.
Luther E. Smith, M.D.

Visiting Ophthalmologist Charles E. Ilipf, M.D.

f Allen F. Voshell, M.D.

Visiting Orthopedic Surgeons , __ ,-, tt t. «^ t^

•^ ^ (Henry F. Ullrich, M.D.

Assistant Visiting Orthopedic Surgeon Milton J. Wilder, M.D.

[John E. Bordley, M.D.
Visiting Laryngolo gists \ Thomas R. O'Rourk, M.D.

[fred T. Kyper, M.D.
Assistant Visiting Laryngologist John H. Hirschfeld, M.D.

fw. Houston Toulson, M.D.

Visiting Urologists , ^^ ^ ,, ^

" * [Hugh Jewett, M.D.

Assistant Visiting Urologist Howard B. Mays, M.D.

[Charles Bagley, M.D.
Visiting Neurological Surgeons I Richard G. Coblentz, M.D.

[James G. Arnold, M.D.

Assistant Visiting Neurological Surgeon R. K. Thompson, M.D.

Visiting Neurologist J. W. Magladery, M.D.

Assistant Visiting Neurologist George G. Merrill, M.D.

Visiting Proctologist Monte Edwards, M.D.

^^. .,. ^ , . , /Grant E. Ward, M.D.

V^s^t^ngOncolog^sts |^^^ ^ g^^^^^ ^^

Visiting Dermatologist Franklin H. Grauer, M.D.

Orthodontist R. Kent Tongue, D.D.S.

A • , ^ IT- -I- r. ^ 7 o /Lawrence W. Bimestefer, D.D.S.

Asststant Vtsittng Dental Surgeon < , , _ ,^ t^ t^ V,

^ * \MicHAEL S. Varipatis, D.D.S.

Visiting Laboratory Physician Julius M. Waghelstein, M.D.

Physiologist Nathan W. Shock, M.D.

Visiting Neuropathologist John A. Wagner, M.D.

THE JAMES LAWRENCE KERNAN HOSPITAL AND

INDUSTRIAL SCHOOL OF MARYLAND FOR

CRIPPLED CHILDREN

STAFF, 1948-1949

Surgeon-in-Chief and Medical Director Allen Fiske Voshell, A.B., M.D.

Consultant in Orthopaedic Surgery and Roentgenology . . . .Albertus Cotton, A.M., M.D.

HISTOR Y OF THE SCHOOL OF MEDICINE 37

(Moses Gellman, B.S., M.D.
Harry Rogers, M.D.
Henry F. Ullrich, M.D.
WiNTHROP M. Phelps, A.B., M.D,
[^Milton J. Wilder, M.D.

Roentgenologist Charles M. Davis, M.D.

Plastic Surgeon Edward A. Kitlowski, A.B., M.D.

Aurist and Laryngologist Benjamin S. Rich, A.B., M.D.

Dentist M. E. Coberth, D.D.S.

Cardiologist Helen M. Taussig, M.D.

fMARY L. Hayleck, M.D.

Pediairists s W. Earl Weeks, M.D.

[Gibson J. Wells, M.D.
Consulting Surgeon Charles Reid Edwards, A.B., M.D.

„ ... t • . J T 1 ■ ^ /Franklin B. Anderson, M.D.

Constdttng Aunsts and Laryngologists \^ . ^ , , -l^ t^ ^ ,

[Edward A. Looper, M.D., D.Oph.

Consulting Neurological Surgeon Charles Bagley, Jr., M.A., M.D.

Consulting Physician Thomas R. Brown, A.B., M.D.

„ u- r, , 1 • , [Harry M. Robinson, Sr., M.D.

Constdttng Dermatologists <^ _ ,,'

\Leon Ginsberg, M.D.

„ ,,. ..J , . , [Irving J. Spear, M.D.

Consulttng Neurologists \ ^ ,. „ ,' ^

[R. V. Seliger, M.D.

_, „. n ,. , . , /benjamin Tappan, A.B., M.D.

Consulting Pedtatnsis Wi- t, ,«--rN

[J. Edmdnd Bradley, M.D.

Consulting Dentist Harry B. McCarthy, D.D.S.

Consulting Pathologist Hugh R. Spencer, M.D.

Roentgenologist Heutry J. Walton, M.D.

S. M. Thompson, M.D.

Resident Orthopaedic Surgeons ,_ .„ ,, ,,^

^ ^ [R. B. Mearns, M.D

Superintendent Miss Maud M. Gardner, R.N.

Dispensary and Social Service Nurse Mrs. Evelyn Byrd Zapf, R.N.

(Miss Elizabeth Lane
Miss Margaret Kennedy
Mrs. Georgiana Wisong

Occupational Therapist Miss Muriel Zimmerman, O.T.

Instructor in Grammar School. . , Miss Bertha Sendelback

HISTORY OF THE SCHOOL OF MEDICINE

The present School of Medicine, with the title University of Maryland School
of Medicine and CoUege of Physicians and Surgeons, is the result of a consolida-
tion and merger of the University of Maryland School of Medicine with the
Baltimore Medical College (1913) and the College of Physicians and Surgeons of
Baltimore (1915).

38 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Through the merger with the Baltimore Medical College, an institution of
thirty-two years' growth, the facihties of the School of Medicine were enlarged in
faculty, equipment and hospital connection.

The CoUege of Physicians and Surgeons was incorporated in 1872, and estab-
lished on Hanover Street in a building afterward known as the Maternite, the
first obstetrical hospital in Maryland. In 1878 union was effected with the
Washington University School of Medicine, in existence since 1827, and the college
was removed to Calvert and Saratoga Streets. Through the consolidation with
the College of Physicians and Surgeons, medical control of the teaching beds in
the Mercy Hospital was obtained.

The School of Medicine of the University of Maryland is one of the oldest foun-
dations for medical education in America, ranking fifth in point of age among the
medical colleges of the United States. It was organized in 1807 and chartered
in 1808 under the name of the College of Medicine of Maryland, and its first
class was graduated in 1810. In 1812 the College was empowered by the Legisla-
ture to annex three other colleges or faculties : Divinity, Law, and Arts and
Sciences; and the four colleges thus united were "constituted an University by the
name and under the title of the University of Maryland."

The original building of the Medical School at the N. E. comer of Lombard and
Greene Streets was erected in 1812. It is the oldest structure in this country
from which the degree of doctor of medicine has been granted annually since its
erection. In this building were founded one of the fi^rst medical libraries and one
of the first medical school libraries in the United States.

At this Medical School dissection was made a compulsory part of the curriculum,
and independent chairs for the teaching of gynecology and pediatrics (1867), and
of ophthalmology and otology (1873), were installed for the fixst time in America.

This School of Medicine was one of the first to provide for adequate clinical
instruction by the erection of its own hospital in 1823. In this hospital intramural
residency for senior students was established for the first time.

The School of Medicine has been co-educational since 1918.

BUILDINGS AND FACILITIES

The original medical building at the N. E. comer of Lombard and Greene
Streets houses the of&ce of the Dean, Room 101, the ofiSce of the Committee on
Admissions, Room 102, two lecture halls, the faculty room and office of the assist-
ant business manager.

The Administration Building, to the east of the original building, contains the
Baltimore offices of the Registrar and two lecture halls.

The laboratory building at 31 South Greene Street is occupied b}' the depart-
ments of Pathology, Bacteriology and Biochemistry.

The Frank C. Bressler Research Laboratory provides the departments of
Anatomy, Histology and Embryology, Pharmacology, Physiology and Clinical
Pathology with facilities for teaching and research. It also houses the research
laboratories of the clinical departments, animal quarters, a laboratory for teaching
Operative Surgery, a lecture hall and the Bressler Memorial Room.

This building was erected in 1939-1940 at 29 South Greene Street opposite the

HISTORY OP THE SCHOOL OF MEDICINE 39

University Hospital. It was built with funds left to the School of Medicine by
the late Frank C. Bressler, an alumnus, supplemented by a grant from the Federal
government. The structure, in the shape of an I, extends east from Greene
Street, just north of the original building.

MEDICAL LIBRARY
HowAKD RovELSTAD, A.B., M.A., B.S.L.S Acting Director of Libraries

Ida Marian Robinson, A.B., B.S.L.S Librarian

Mary Elizabeth Hicks, A.B., B.S.L.S Assistant Librarian

Florence R. Kirk Assistant Librarian

Edith R. McIntosh, A.M., A.B.L.S Cataloguer

Charlotte Jubb Assistant to the Cataloguer

The Medical Library of the University of Maryland, founded in 1813 by the
purchase of the collection of Dr. John Crawford, now numbers 29,400 volumes and
several thousand pamphlets and reprints. Over four hundred of the leading
medical journals, both foreign and domestic, are received regularly. The library
is housed in Davidge Hall, a comfortable and commodious building in close prox-
imity to classrooms and laboratories, and is open daily for the use of members of
the faculty, the student body and the profession generally. Libraries pertaining
to particular phases of medicine are maintained by several departments of the
medical school.

The library of the Medical and Chirurgical Faculty of Maryland and the Welch
Medical Library are open to students of the medical school without charge.
Other libraries of Baltimore are the Peabody Library and the Enoch Pratt Free
Library.

DISPENSARY BUILDING

The old hospital building has been remodeled and is occupied by the Out-patient
Department. Thus the students have been provided with a splendidly appointed
group of clinics for their training in out-patient work. All departments of clinical
training are represented in this remodeled building and all changes have been
predicated on the teaching function for which this department is intended.

The office of the Medical School Physician is located in this building.

The Department of Art also occupies quarters here.

UNIVERSITY HOSPITAL

The University Hospital, which is the property of the University of Maryland,
is the oldest institution for the care of the sick in the state of Maryland. It was
opened in September 1823, under the name of the Baltimore Infirmary, and at
that time consisted of but four wards, one of which was reserved for patients with
diseases of the eye.

In 1933-1934 the new University Hospital was erected and patients were
admitted to this building in November 1934. The new hospital is situated at the
southwest corner of Redwood and Greene Streets, and is consequently opposite
the medical school buildings. The students, therefore, are in close proximity

40 TEE SCHOOL OF MEDICINE, UNIVERSITY OP MARYLAND

and little time is lost in passing from the lecture halls and laboratories to the
clinical facilities of the new building.

This new building, with its modem planning, makes a particularly attractive
teaching hospital and is a very valuable addition to the cHnical facilities of the
medical school.

The new hospital has a capacity of 435 beds and 65 bassinets devoted to general
medicine, surgery, obstetrics, pediatrics, and the various medical and surgical
specialties.

The teaching zone extends from the second to the eighth floor and comprises
wards for surgery, medicine, obstetrics, pediatrics, and a large clinical lecture hall.
There are approximately 270 beds available for teaching.

The space of the whole north wing of the second floor is occupied by the de-
partment of roentgenology. The east wing houses clinical pathology and special
laboratories for clinical microscopy, biochemistry, bacteriology, and an especially
well appointed laboratory for students' training. The south wing provides space
for electro-cardiographic and basal metabolism departments, with new and very
attractive air-conditioned or oxygen therapy cubicles. The west wing contains
the departments of rhinolaryngology and bronchoscopy, industrial surgery, oph-
thalmology, and male and female cystoscopy.

The third and fourth floors each provide two medical and two surgical wards.
The fifth floor contains two wards for pediatrics, and on the sixth floor there are
two wards for obstetrics. Each ward occupies the space of one wing of the
hospital.

On the seventh floor is the general operating suite, the delivery suite, and the
central supply station. The eighth floor is essentially a students' floor and affords
a mezzanine over the operating and dehvery suites, and a students' entrance to
the clinical lecture hall.

In the basement there is a very well appointed pathological department with a
large teaching autopsy room and its adjunct service of instruction of students in
pathological anatomy.

The hospital receives a large number of accident patients because of its prox-
imity to the largest manufacturing and shipping districts of the city.

The obstetrical service is particularly well arranged and provides accommoda-
tion for forty ward patients. This service, combined with an extensive home
service, assures the student abundant obstetrical training.

During the year ending December 31, 1947, 2535 cases were delivered in the
hospital and 815 cases in the outdoor department. Students in the graduating
class observed at least thirty-five cases, each student being required to deliver at
least ten patients in their homes.

The dispensaries associated with the University Hospital and the Mercy Hospi-
tal are organized upon a uniform plan in order that the teaching may be the same
in each. Each dispensary has the following departments: medicine, surgery,
pediatrics, ophthalmology, otology, genito-urinary, gynecology, gastroenterology,
neurology, orthopaedics, proctology, dermatology, larjmgology, rhinology, car-
diology, tuberculosis, psychiatry, oral surgery and oncology.

All students in their junior year work each day during one-third of the year

HISTORY OF THE SCHOOL OF MEDICINE 41

in the departments of medicine and surgery of the dispensaries. In their senior
year, all students work one hour each day in the special departments.

MERCY HOSPITAL

The Sisters of Mercy first assumed charge of the Hospital at the comer of Cal-
vert and Saratoga Streets, then owned by the Washington University, in 1874.
By the merger of 1878 the Hospital came under the control of the College of
Physicians and Surgeons, but the Sisters continued their work of ministering to the
patients.

In a very few years it became apparent that the City Hospital, as it was then
called, was much too small to accommodate the rapidly growing demands upon it.
However, it was not until 1888 that the Sisters of Mercy, with the assistance of
the Faculty of the College of Physicians and Surgeons, were able to lay the comer-
stone of the present hospital. This building was completed and occupied late in
1889. Since then the growing demands for more space have compelled the erec-
tion of additions, until now there are accommodations for 348 patients.

In 1909 the name was changed from The Baltimore City Hospital to Mercy
Hospital.

The clinical material in the free wards is under the exclusive control of the
Faculty of the University of Maryland School of Medicine and College of Physi-
cians and Surgeons.

THE BALTIMORE CITY HOSPITALS

The clinical facilities of the School of Medicine have been largely increased by
the liberal decision of the Department of Public Welfare to allow the use of the
wards of these hospitals for medical education. The autopsy material also is
available for student instruction.

Members of the junior class make daily visits to these hospitals for clinical
instmction in medicine, surgery, and the specialties.

The Baltimore City Hospitals consist of the following separate divisions:
The General Hospital, 400 beds, 90 bassinets.
The Hospital for Chronic Cases, 575 beds.
The Hospital for Tuberculosis, 280 beds.
Infirmary (Home for Aged) 700 beds.

THE JAMES LAWRENCE KERN AN HOSPITAL AND INDUSTRIAL SCHOOL OF
MARYLAND FOR CRIPPLED CHILDREN

This institution is situated on an estate of 75 acres at Dickeyville. The site
is within the northwestern city limits and of easy access to the city proper.

The location is ideal for the treatment of children, in that it affords all the ad-
vantages of sunshine and country air.

A hospital unit, complete in every respect, offers all modem facilities for the
care of any orthopaedic condition in children.

The hospital is equipped with 100 beds — endowed, and city and state supported.

The orthopaedic dispensary at the University Hospital is maintained in closest
affiliation and cares for the cases discharged from the Keman Hospital. The

42 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

physical therapy department is very well equipped with modem apparatus
and trained personnel. Occupational therapy has been fully established and
developed under trained technicians.

THE BALTIMORE EYE, EAR, AND THROAT HOSPITAL

This institution was first organized and operated in 1882 as an outgrowth of the
Baltimore Eye and Ear Dispensary, which closed on June 14, 1882^ The name
then given to the new hospital was The Baltimore Eye and Ear Charity Hospital.
It was located at the address now known as 625 W. Franklin St. The out-patient
department was opened on September 18, 1882 and the hospital proper on
November 1 of the same year. In 1898 a new building afforded 24 free beds
and 8 private rooms; by 1907 the beds nimibered 47; at present there are 60 beds,
29 of which are free. In 1922 the present hospital building at 1214 Eutaw Place
was secured and in 1926 the dispensary was opened. In 1928 a clinical laboratory
was installed. During 1947 the out-patient visits numbered 20,119.

Through the kindness of the Hospital Board and Staff, our junior students
have access to the dispensary which they visit in small groups for instruction in
ophthalmology.

STANDARD REQUIREMENTS FOR ADMISSION 43

REQUIREMENTS FOR ADMISSION

METHOD OF MAKING APPLICATION

Requests for application forms should be filed not earlier than September 15th
preceding by one year the desired date of admission. These forms may be secured
from the Committee on Admissions, School of Medicine, University of Maryland,
Baltimore 1, Maryland.

APPLICATION FOR ADMISSION TO THE FIRST YEAR

Application for admission is made by filing the required form and by having all
pertinent data sent directly to the Committee on Admissions, in accordance with
the instructions accompanying the application.

Consideration will not be given applications received after January 31st except
contingent upon places being available.

APPLICATION FOR ADMISSION TO ADVANCED STANDING

Students who have attended approved medical schools are eligible to file ap-
plications for admission to the second- and third-year classes only. These ap-
plicants must be prepared to meet the current first-year entrance requirements in
addition to presenting acceptable medical school credentials, and a medical school
record based on courses which are quantitatively and qualitatively equivalent to
similar courses in this school.

Application to advanced standing is made in accordance with the instructions
accompanying the application form.

Persons who already hold the degree of Doctor of Medicine will not be admit-
ted to the Medical School as a candidate for that degree from this university.

MINIMUM REQUIREMENTS FOR ADMISSION
The minimum requirements for admission to the School of Medicine are:

(a) Graduation from an approved secondary school, or the equivalent in

entrance examinations, and

(b) Three academic years of acceptable college credit, exclusive of physical edu-

cation and military sciences, earned in an approved college of arts and
sciences. The quantity and quality of this course of study shall be equiv-
alent to that required for recommendation by the institution where the
college courses are being, or have been, pursued.

pleted by June of the year the applicant desires to be admitted:

Semester hours Quarter hours

General biology or zoology 8 12

Inorganic chemistry 8 12

Organic chemistry 6-8 9-12

General physics 8 12

English 6 9

Modern language (German, French, Spanish) .... 6 9

44 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

(d) The total semester-hour or quarter-hour credits presented must be equiv-

alent in quantity and quality to three-fourths of the credit requirement
for graduation by the recommending institution, exclusive of courses in
physical education and military sciences.
Applicants who are unable to complete these requirements by June of the
year admission is desired, wiU be considered contingent on places being
available, provided all basic required courses and credits shall have been
absolved by June as indicated in (c) above.

(e) Students who are conditioned in college courses are not accepted.

Elective courses should be selected from the following three groups:

Humanities Natural Sciences Social Sciences

English (an advanced Vertebrate Embryology Economics

course in English Comparative Vertebrate History

composition should Anatomy Political Science

be taken, if possible) Quantitative Analysis Psychology (a basic

Scientific German or Ph}^ical Chemistry course is desirable)

French (A reading Mathematics Sociology, etc.

knowledge of either

language is desirable,

although German is

preferred)
Philosophy

Careful attention should be given to the selection of elective courses in the
natural sciences. Accordingly, it is suggested that the elective hst given above
be a guide in this connection and that the remainder of the college credits be
accumulated from courses designed to promote a broad cultural development.
Students should avoid the inclusion of college courses in subjects that occur in the
medical curriculum, for example, histology, histological technique, human anat-
omy, bacteriology, physiology, neurology, physiological chemistry.

It is not intended that these suggestions be interpreted to restrict the education
of students who exhibit an aptitude for the natural sciences or to limit the de-
velopment of students who plan to follow research work in the field of medicine.

In accepting candidates for admission, preference will be given to those appli-
cants who have acceptable scholastic records in secondary school and college,
satisfactory scores in the Medical College Admission Test, favorable letters of
recommendation from their premedical committees, or from one instructor in
each of the departments of biology, chemistry, and physics, and who in all other
respects give every promise of becoming successful students and physicians of high
standing.

Those candidates for admission who are unconditionally accepted will receive
a certificate of matriculation from the office of the Dean.

COMBESTED COURSE IN ARTS AND SCIENCES AND MEDICINE

A combined seven years' curriculum leading to the degrees of Bachelor of
Science and Doctor of Medicine is offered by the University of Maryland. The
first three years are taken in residence in the College of Arts and Sciences at Col-
lege Park, and the last four years in the School of Medicine in Baltimore. (See

STANDARD REQUIREMENTS FOR ADMISSION 45

University catalogue for details of quantitative and qualitative college course
requirements.)

If a candidate for the combined degree completes the work of the first year in
the School of Medicine with an average of "C" or better, and if he has absolved
the quantitative and qualitative college requirements set up by the University,
he is eligible to recommendation by the Dean of the School of Medicine that the
degree of Bachelor of Science be conferred.

Because the general commencement at College Park usually takes place before
the School of Medicine is prepared to release grades of the first-year class, this
combined degree of Bachelor of Science is conferred at the commencement follow-
ing the candidate's second year of residence in the School of Medicine.

STATE MEDICAL STUDENT QUALIFYING CERTIFICATES

Candidates for admission who live in or expect to practice medicine in Pennsyl-
vania, New Jersey or New York, should apply to their respective state boards of
education for medical student qualifying certificates (Pennsylvania and New
Jersey) or approval of applications for medical student qualifying certificates
(New York).

Those students who are accepted must file satisfactory State certificates in the
office of the Committee on Admissions, School of Medicine, before registration.
No exceptions will be made to this requirement.

Addresses of the State Certifying Offices

Director of Credentials Section, Pennsylvania Department of Public In-
struction, Harrisburg, Pa.

Chief of the Bureau of Credentials, New Jersey Department of Public In-
struction, Trenton, N. J.

Supervisor of Qualifying Certificates, The State Education Department,
Examinations and Inspections Division, Albany, N. Y.

DEFINITION OF RESIDENCE STATUS OF STUDENTS*

Students who are minors are considered to be resident students if, at the time
of their registration, the parents* have been residents of this State for at least
one year.

Adult students are considered to be resident students if, at the time of their
registration, they have been residents of this State for at least one year, provided
such residence has not been acquired while attending any school or college in
Maryland.

The status of the residence of a student is determined at the time of his first
registration in the university and may not thereafter be changed by him unless,
in the case of a minor, his parents* move to and become legal residents of this
state by maintaining such residence for at least one full calendar year. However,
the right of the student (minor) to change from a non-resident to a resident status
must be estabhshed by him prior to registration for a semester in any academic
year.

* The term "parents" includes persons who, by reason of death or other unusual
circumstances, have been legally constituted the guardians of or stand in loco parentis
to such minor students.

46 THE SCHOOL OP MEDICINE, UNIVERSITY OP MARYLAND

CURRENT FEES

Matriculation fee (paid once) $10.00

Tuition fee (each year) — Residents of Maryland 450.00

Tuition fee (each year) — Non-Residents 600.00

Laboratory fee (each year) 25 .00

Student health service fee (each year) 20.00

Student activities and service fee (each year) 15 . 00

*Lodging and meals fee 6. 75

Graduation fee 15 .00

Re-examination fee (each subject) 5 . 00

Transcript fee to graduates. First copy gratis, each copy thereafter. . 1 .00

RULES FOR PAYMENT OF FEES

No fees are returnable.

Make all checks or money orders payable to the "University of Maryland".

When offering checks or money orders in payment of tuition and other fees,
students are requested to have them drawn in the exact amount of such fees.
Personal checks whose face value is in excess of the fees due will be accepted for
collection only.

Acceptance. — Payment of the matriculation fee of $10.00 and of a deposit on
tuition of $50.00 is required of accepted applicants before the expiration date
specified in the offer of acceptance. This $60.00 deposit is not returnable and
will be forfeited if the applicant fails to register, or it will be applied to the appli-
cart's first semester's charges on registration.

Registration. — All students, after proper certification, are required to register
at the business office, Gray Laboratory. (See calendar page 5 of this bulletin
for dates for the payments of fees, and the note regarding late registration fee.)

One-half of the tuition fee, the laboratory fee, the student health fee, the mainte-
nance and service fee and the student activities fee are payable on the date specified
for registration for the first semester.

The remainder of the tuition fee shaU be paid on the date designated for the
payment of fees for the second semester. Fourth year students shall pay the
graduation fee, in addition, at this time.

PENALTY FOR NON-PAYMENT OF FEES

If semester fees are not paid in full on the specified registration dates, a penalty
of $5.00 will be added.

If a satisfactory settlement, or an agreement for settlement, is not made with

the business office within ten days after a payment is due, the student automatically
is debarred from attendance on classes and will forfeit the other privileges of the
School of Medicine.

* Jimior Students will be bLUed for this fee, covering lodging and meals while on obstet-
rical service at Baltimore City Hospitals. Accordingly, Section B. on Schedule 2 will be
bUled for the first semester; Section A on Schedule 2 for the second semester.

FEES AND PERSONAL EXPENSES 47

REEXAMINATION FEE

A student who is eligible to reexaminations must pay the business office $5.00 for
each subject in which he is to be examined, and he must present the receipt to the
faculty member giving the examination before he will be permitted to take the
examination.

STUDENT ACTIVITIES AND SERVICE FEE

This fee pays for the use of clothing lockers, provides library privileges, main-
tains student loan collections, a student lounge and cafeteria. It supports a rec-
reational program for students of all classes, provides photographs for all school
purposes, including state boards, and furnishes graduates with invitations and
tickets to the Pre-commencement Exercises. It supports the activities of the
Student Coucil.

STUDENT ACTIVITIES FEE

This fee is used to maintain a recreational program for students of all classes
in addition to supporting the activities of the Student Council.

STUDENT HEALTH SERVICE

James R. Kakns, M.D Director, Student Health Service.

The Medical School has made provision for the systematic care of students ac-
cording to the following plan:

1. Preliminary Examination — All new students will be examined during the
first week of the semester. Notice of the date, time, and place of the examination
will be announced to the classes and on the bulletin board. The passing of this
physical examination is necessary before final acceptance of any student.

2. Medical Attention — Students in need of medical attention will be seen by
the school physician. Dr. James R. Kams, in his office at the medical school, at
9 A.M. daily, except Saturday and Sunday. In case of necessity, students will be
seen at their homes.

3. Hospitalization— li it becomes necessary for any student to enter the hospital
during the school year, the school has arranged for the payment of part or all of his
hospital expenses, depending on the length of his stay and special expenses incur-
red. This appHes only to students admitted through the school physician's office.

4. Physical Defects — Prospective students are advised to have any known
physical defects corrected before entering school in order to prevent loss of time
which later correction might incur.

5. Eye Examination — Each new matriculate is required to undergo an eye
examination at the hands of an oculist (Doctor of Medicine) within three months
before entering the School of Medicine. Long study hours bring out unsuspected
eye defects which cause much loss of time and inefficiency in study if not
corrected until after school work is under way.

6. Limitations — It is not the function of this service to treat chronic conditions
contracted by students before admission, nor to extend treatment to acute condi-
tions arising in the period between academic years, unless the school physician
recommends this service.

48 TEE SCHOOL OP MEDICINE, UNIVERSITY OP MARYLAND

GENERAL RULES

The right is reserved to make changes in the curriculum, the requirements for
graduation, the fees and in any of the regulations whenever the university
authorities deem it expedient. Students are urged, therefore, to read the latest
issue of the catalogue and follow the rules set forth therein.

ADVANCEMENT AND GRADUATION

1. All students are required to take the spring examinations unless excused by
the Dean.

2. a. When a student has failures in two completed major courses, he or she
shall be dropped from the roUs of the Medical School, b. Any student who fails
or is failing in two major subjects at the end of the first semester of the freshman
year, whether the course is complete or incomplete, may be dropped from the
rolls of the school.

3. No student will be permitted to pass to a higher class with conditions.

4. Should a student be required to repeat any year in the course, he must pay
regular fees.

5. A student failing in final examinations for graduation at the end of the fourth
year will be required to repeat the entire course of the fourth year and to take
examinations in such other branches as may be required, should he again be
permitted to enter the school as a candidate for graduation.

6. The general fitness of a candidate for graduation, as well as the results of his
examinations, will be taken into consideration by the faculty.

EQUIPMENT

7. At the beginning of the first year, all students must be prepared to provide
microscopes of a satisfactory type equipped with a mechanical stage and a sub-
stage lamp.

A standard microscope of either Bausch & Lomb, Leitz, Spencer, or Zeiss make,
fitted with the following attachments, will meet the requirements:

Oculars: 10 x and 5 x.

Triple nose piece with 16 mm., 4 mm., and 1.9 mm. 125 N.A. oil immersion lens.

Wide aperture stage with quick screw condenser.

All used microscopes are subject to inspection and approval before their use
in the laboratory is permitted. The student is cautioned against the purchase of
such an instrument before its official approval by the school.

8. Students in the second year class are required to provide stethoscopes.

9. Third- and fourth-year students are required to provide haemocytometers,
opthalmoscopes and otoscopes.

HOUSING
There are no housing or living accommodations on the campus of the medical
school.

PARKING
Because of lack of space on the university parking lots no parking facilities
are provided thereon for students.

GENERAL RULES 49

STATE QUALIFYING CERTIFICATES

10. Candidates for admission who live in or expect to practice medicine in
Pennsylvania, New Jersey or New York must file State qualifying certificates in
the ofl&ce of the Committee on Admissions, School of Medicine, before registration.
No exception wUl be made to this rule.

EYE EXAMINATION BEFORE ADMISSION

11. Each new matriculate in each class is required to present to the Committee
on Admissions a certificate from an oculist, (a graduate in medicine) that the
matriculate's eyes have been examined and are in condition, with or without
glasses as the case may be, to endure the strain of close and intensive reading.

It is required that this examination be completed within three months prior to
registration and that the certificate be mailed to the Committee on Admissions
not later than one month before registration.

AWARDING OF COMBINED DEGREES

12. Students entering the School of Medicine on a three-year requirement basis
from colleges which usually grant a degree on the successful completion of the first
year of medicine, are restricted by the following regulations:

a — The candidate must present a certificate from his college or university that
he has absolved the quantitative and qualitative premedical requirements
for this degree.

b — The candidate must acquire an average of "C" or better for the work of
his first year in the School of Medicine.

c — The Dean of the School of Medicine reserves the right to withhold his
recommendation that a bachelor's degree be conferred at a commencement
which occurs before the official release of first -year medical grades.

COST OF TRANSCRIPTS

13. Graduates will receive the first transcript of record without charge. Subse-
quent copies will cost one dollar each. Requests for transcripts must be filed
with the Registrar's Office, University of Maryland, Lombard and Greene
Streets, Baltimore-1, Maryland.

LIBRARY REGULATIONS

Loan Regulations

Loan periods have been worked out according to demand for and protection of
different types of material.

Two-Week Loans: All books except those on reserve.

Three-Day Loans: All journals except the latest number (which does not

circulate), and those on reserve.

Overnight Loans: Books and journals on reserve.

(4p.m.-10a.m.)
Special Rules or Books on Reserve:

Students whose names appear on the check-list for the Mercy Hospital section
will be granted the necessary hours to return reserve books.

so THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Overnight books may be reserved in advance only within the week in which they
will be used. Books may be reserved on Saturday for the following Monday.
Overnight books may not be reserved two successive nights by the same person.
Advance reserves will be held until one hour before closing.
Fines

Fines are imposed not to acquire money, but to assure equal access to books-
Two-Week Loans: 5 jl per day.
Three-Day Loans: 5^ per day.
Overnight Loans: 5^ per hour.

Lost Books: List price of the book. (Lost books should be reported at once)
All books must be returned, lost books replaced or paid for, and fines paid before
a student can finish the year in good standing.
In fairness to all concerned, these rules must be enforced without exception.

PRIZES

THE FACULTY PRIZE

The faculty will award the gold medal and certificate and five certificates of
honor to those six of the first ten highest ranking candidates for graduation who,
during the four academic years, have exhibited outstanding qualifications for the
practice of medicine.

THE DR. A. BRADLEY GAITHER MEMORIAL PRIZE

A prize of $25.00 is given each year by Mrs. A. Bradley Gaither as a memorial
to the late Dr. A. Bradley Gaither, to the student in the senior class doing the best
work in genito-urinary surgery.

THE WILLIAM D. WOLFE MEMORIAL PRIZE

(Value $100.00 each)
A certificate of proficiency and a prize of $100.00 will be awarded, each year
until the fund is dissipated, to the graduate, selected by the Faculty Board, show-
ing greatest proficiency in Dermatology.

SCHOLARSHIPS

All scholarships are assigned for one academic year, unless specifically reawarded
on consideration of an application.

OflBcial application forms are obtainable at the Dean's oflfice, where they should
be filed four months before the ensuing academic year.

THE DR. SAMUEL LEON FRANK SCHOLARSHIP
(Value $100.00)

This scholarship was established by Mrs. Bertha Rayner Frank as a memorial
to the late Dr. Samuel Leon Frank, an alumnus of this university.

It is awarded by the Trustees of the Endowment Fund of the University each
year upon nomination by the Faculty Board "to a medical student of the Uni-
versity of Maryland, who in the judgment of said Council, is of good character
and in need of pecuniary assistance to continue his medical course."

This scholarship is awarded to a second, third or fourth year student who has
successfully completed one year's work in this school. No student may hold
this scholarship for more than two years.

SCHOLARSHIPS 51

THE CHARLES M. HITCHCOCK SCHOLARSHIPS
(Value $100.00 each)
Two scholarships were established from a bequest to the School of Medicine
by the late Charles M. Hitchcock, M.D., an alumnus of the university.

These scholarships are awarded annually by the Trustees of the Endowment
Fund of the University, upon nomination by the Faculty Board, to students
who have meritoriously completed the work of at least the first year of the course
in medicine, and who present to the Board satisfactory evidence of a good moral
character and of inability to continue the course without pecuniary assistance.

THE RANDOLPH WINSLOW SCHOLARSHIP
(Value $100.00)

This scholarship was established by the late Randolph Winslow, M.D., LL.D.

It is awarded annually by the Trustees of the Endowment Fund of the Univer-
sity, upon nomination by the Faculty Board, to a "needy student of the Senior,
Junior, or Sophomore Class of the Medical School."

"He must have maintained an average grade of 85% in all his work up to the
time of awarding the scholarship."

"He must be a person of good character and must satisfy the Faculty Board
that he is worthy of and in need of assistance."

THE DR. LEO KARLINSKY MEMORIAL SCHOLARSHIP

(Value $125.00)

This scholarship was established by Mrs. Ray Mintz Karlinsky as a memorial
to her husband, the late Dr. Leo Karlinsky, an alumnus of the university.

It is awarded annually by the Trustees of the Endowment Fund of the Univer-
sity, upon the nomination of the Faculty Board, to "a needy student of the
Senior, Junior or Sophomore Class of the Medical School."

He must have maintained in all his work up to the time of awarding the scholar-
ship a satisfactory grade of scholarship.

He must be a person of good character and must satisfy the Faculty Board
that he is worthy of and in need of assistance.

THE UNIVERSITY SCHOLARSHIP

A scholarship which entitles the holder to exemption from payment of tuition
fee for the year, is awarded annually by the Faculty Board to a student of the
senior class in need of assistance who presents to the Faculty Board satisfactory
evidence of good character and scholarship.

THE FREDERICA GEHRMANN SCHOLARSHIP
(Value $200.00)
(Not open to holders of Warfield and Cohen Scholarships)
This scholarship was established by the bequest of the late Mrs. Frederica
Gehrmann and is awarded to a third-year student who at the end of the second
year has passed the best practical examinations in physiology, pharmacology,
pathology, bacteriology, immunology, serology, surgical anatomy and neuro-
anatomy.

52 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

THE CLARENCE AND GENEVRA WARFIELD SCHOLARSHIPS
(Value $300.00 each)

There are five scholarships established by the regents from the income of the
fund bequeathed by the will of Dr. Clarence Warfield.

Terms and Conditions: These scholarships are available to students of any of
the classes of the course in medicine. Preference is given to students from the
counties of the state of Maryland which the Faculty Board may from time to
time determine to be most in need of medical practitioners.

Any student receiving one of these scholarships must agree, after graduation
and a year's internship, to undertake the practice of medicine, for a term of two
years, in the county to which the student is accredited, or in a county selected by
the Board. In the event that a student is not able to comply with the condition
requiring him to practice in the county to which he is accredited by the Board,
the money advanced by the regents shall be refunded by the student.

THE ISRAEL AND CECELIA. E. COHEN SCHOLARSHIP

(Value $150.00)

This scholarship was established by the late Eleanor S. Cohen in memory of
her parents, Israel and Cecelia E. Cohen. Terms and conditions: This scholarship
will be available to students of any one of the classes of the course in medicine;
preference is given to students of the counties in the state of Maryland which the
Faculty Board may from time to time determine to be most in need of medical
practitioners. Any student receiving one of these scholarships must, after gradua-
tion and a year's internship, agree to undertake the practice of medicine for a term
of two years in the county to which the student is accredited, or in a county se-
lected by the council. In the event that a student is not able to comply with
the condition requiring him to practice in the county to which he is accredited by
the Board, the money advanced by the regents shall be refunded.

THE DR. HORACE BRUCE HETRICK SCHOLARSHIP

(Value $125.00)

This scholarship was established by Dr. Horace Bruce Hetrick as a memorial
to his sons, Bruce Hayward Hetrick and Augustus Christian Hetrick. It is to
be awarded by the Faculty Board to a student of the senior class.

THE HENRY ROLANDO SCHOLARSHIP
(Value approximately $250.00)

The Henry Rolando Scholarship was established by the Board of Regents of
the University of Maryland from a bequest to the Board by the late Anne H.
Rolando for the use of the Faculty of Medicine.

This scholarship will be awarded each academic year on the recommendation
of the Faculty Board to a "poor and deserving student."

THE READ SCHOLARSHIPS

The sum of $500.00 is now available to cover two (2) scholarships in the
amount of $250.(X) each for the scholastic year, beginning in 1945, as a dona-

ORGANIZATION OF THE CURRICULUM 53

tion from the Read Drug and Chemical Company of Baltimore, Maryland.
Two students are to be selected by the Dean of the School in collaboration
with the Scholarship and Loan Committee of the Medical School with the pro-
vision that the students selected shall be worthy, deserving students, residents
of the State of Maryland.

LOAN FUNDS

W. K. KELLOGG FUND

This loan fund was established in the academic year 1942 with money granted
by the W. K. KeUogg Foundation. The interest paid on the loans, together with
the principal of the fund as repaid, will be used to found a rotating loan fund.
Loans will be made on the basis of need, character and scholastic attainment.

FACULTY OF MEDICINE LOAN FUND

A Faculty of Medicine Loan Fund was established with money derived from
the bequest of Dr. William R. Sanderson, Class 1882, and the gift of Dr. Albert
Stein, Class 1907. Loans will be made on the basis of need, character, and
scholastic ability.

THE JAY W. EATON LOAN FUND

This fund was established by the local chapter of the Nu Sigma Nu Fraternity
in memory of Jay W, Eaton of the class of 1946.

Beginning in 1946 an interest-free loan of $100.00 will be made to some worthy
member of the senior class, on recommendation of the Scholarship Committee of
the School of Medicine. This loan is to be credited to the tuition fee of the ap-
pointed student and is to be repaid by the student within four years following his
graduation.

THE SENIOR CLASS LOAN FUND

The senior class of 1945 originated this fund which will accumulate by subscrip-
tion from among members of each senior class.

The conditions of the agreement provide that the dean of the School of Medicine
award a loan of $100.00 to a needy member of the senior class on the recommenda-
tion of a self-perpetuating committee of two members of the faculty.

Loans from this fund are to be credited to the tuition fee of the appointed
student and are to be repaid within five years from the date of graduation.

ORGANIZATION OF THE CURRICULUM

The curriculum is organized under thirteen departments.

1. Anatomy (including Histology and Embryology).

2. Physiology.

3. Bacteriology and Immunology.

4. Biological Chemistry.

5. Pharmacology and Materia Medica.

6. Pathology.

7. Medicine (including Medical Specialties).

54 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

8. Surgery (including Surgical Specialties).

9. Obstetrics.

10. Gynecology.

11. Ophthalmology.

12. Roentgenology.

13. Anaesthesiology.

The instruction is given in four academic years of graded work.

Several courses of study extend through two years or more, but in no case are
the students of different years thrown together in the same course of teaching.

The first and second years are devoted largely to the study of the structures,
functions and chemistry of the normal body. Laboratory work occupies most of
the student's time during these two years.

Some introductory instruction in medicine and surgery is given in the second
year. The third and fourth years are almost entirely clinical.

A special feature of instruction in the school is the attempt to bring together
teacher and student in close personal relationship. In many courses of instruc-
tion the classes are divided into small groups and a large number of instructors
insures attention to the requirements of each student.

In most courses the final examination as the sole test of proficiency has dis-
appeared and the student's final grade is determined largely by partial examina-
tions, recitations and assigned work carried on throughout the course.

DEPARTMENT OF GROSS ANATOMY

Eduaed Uhxenhxtth Professor of Anatomy

Frank H. J. Figge Professor of Experimental Anatomy

Veenon E. Krahl Associate Professor of Gross Anatomy

R. Dale Smith Assistant Professor of Gross Anatomy

Karl F. Mech Instructor in Gross Anatomy

Jomsf Shelby Metcalf Weaver Fellow in Gross Anatomy^

Walter G. Reich, Jr Weaver Fellow in Gross Anatomy^

Edmund B. Middleton Weaver Fellow in Gross Anatomy'

Otto C. Brantigan Professor of Surgical Anatomy

W. Wallace Walker Assistant Professor of Surgical Anatomy

William B. Settle Associate in Surgical x\natomy

Herbert E. Reieschneider Associate in Surgical Anatomy

Henry L. Rigdon Associate in Surgical Anatomy

Harry C. Bowie Instructor in Surgical Anatomy

Ross Z. PiERPONT Instructor in Surgical Anatomy

George H. Brouillet Assistant in Surgical Anatomy

1 March to June 30, 1948.

2 November to June 30, 1948.

3 July 1 to August 31, 1948.

ORGANIZATION OF THE CURRICULUM 55

. Gross Anatomy. First Year. First semester. Six lectures and conferences
and seventeen laboratory hours a week during the first thirteen weeks; eleven lec-
tures and conferences and twenty-seven laboratory hours a week during the follow-
ing two weeks.

This course comprises the dissection of the head, neck, chest, abdomen, pelvis
and upper extremity; in addition, there is presented an extensive demonstration
course of specially dissected preparations of the pelvis and perineum, and a sepa-
rate lecture course on the peripheral nervous system. Members of the staff.

First Year. Second semester. One lecture and four laboratory hours a week
during February and March, comprising the dissection of the lower extremity.
Drs. Krahl and Smith.

First semester 345 hours

Second semester 40 hours

Total 385 hours

Topographic and Surgical Anatomy. Second Year. The course is designed
to bridge the gap between abstract anatomy and clinical anatomy as applied to
the study and practice of medicine and surgery. Students are required to dissect
and to demonstrate aU points, outlines, and regions on the cadaver. Underlying
regions are dissected to bring out outlines and relations of structures.

Two lectures and two laboratory periods are given each week during the second
semester. Drs. Brantigan, Walker, Settle, Reifschneider, Rigdon, Bowie, Pier-
pont and BrouUlet.

Total hours: 96

Advanced Anatomy (elective course). Selected problems in gross anatomy.
This course is intended to offer to the advanced medical student and the f)ost-
graduate student an opportunity of extending the knowledge secured in the pre-
scribed anatomy courses. Drs. Uhlenhuth and Brantigan.

In addition to the above course, facilities for special anatomical problems are
offered to the more advanced student and physician.

Graduate Courses. Consult the catalog of the Graduate School for descriptions
of the graduate courses offered by members of the staff.

Postgraduate Courses. Consult the description of postgraduate courses in gross
anatomy and surgical anatomy.

DEPARTMENT OF HISTOLOGY AND EMBRYOLOGY

1 Professor of Anatomy

O. G. Harne Associate Professor of Histology

John F. Lutz Assistant Professor of Histology

1 Associate in Histolog}.'

First Year. The course in histology is divided equally between the study of
the fundamental tissues and that of organs. Throughout the entire course the
embryology of the part being studied precedes the study of the fully developed

^ To be appointed

56 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

tissue. Thus embryology becomes a correlated part of the whole subject of micro-
scopic anatomy and not an independent subject.

Each student is furnished a set of histological slides, previously prepared in our
own laboratory, thus insuring a uniform and satisfactory quality of material for
study and permitting the time of the student to be expended in the study of ma-
terial rather than in the technic of its preparation. The object of the course is to
present the evidence of function as shown by the structure of tissues and organs.
Drs. Harne and Lutz.

An optional laboratory course is offered. This supplements the required course
giving laboratory experience which can not be incorporated in the former. No
added charge is made for the course.

Total hours: 150.

NEURO-ANATOMY

First Year. Neuro-anatomy embraces a study of the fundamental structure of
the central nervous system as apphed to its function. An abundance of material
permits of individual dissection of the human brain. A series of appropriately
stained sections of the human brain stem is furnished each student for the micro-
scopic study of the internal structure of the nervous system. Drs. Harne and Lutz.

Total hours: 100.

Gradtmte Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.

DEPARTMENT OF PHYSIOLOGY

William R. Amberson Professor of Physiology

Dietrich Conrad Smith Associate Professor of Physiology

Robert H. Oster Professor of Physiology, School of Dentistry

Mary E. Chinn Instructor in Physiology

Sylvia Himmelfarb Assistant in Physiology

Frances C. Brown, A.B Assistant in Physiology

Raymond F. Kline Porter Fellow in Physiology

Hans Ludes Research Assistant in Physiology

John S. Metcale, Jr Research Assistant in Physiology

The work in physiology is given in two separate courses:

First Year. Second Semester. A course in neurophysiology is presented in
two lectures a week, without laboratory work.

Second Year. First Semester. The remainder of the subject is presented in
four lectures, one conference, and two laboratory periods a week.

The fundamental concepts of physiology are presented with special reference
to mammalian problems.

Total hours: 224.

Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.

ORGANIZATION OF THE CURRICULUM 57

DEPARTMENT OF BACTERIOLOGY AND IMMUNOLOGY

Frank W. Hachtel Professor of Bacteriology

^ Assistant Professor of Bacteriology

H. Edmttnd Levin Associate in Bacteriology

Hazel Y. Pruitt Assistant in Bacteriology

Second Year. First Semester. The principles of general bacteriology are
taught by quiz, conference, and lecture.

Instruction given in the laboratory includes the methods of preparation of
culture media, the study of pathogenic bacteria, and the bacteriological examina-
tion of water and milk. The bacteriological diagnosis of communicable diseases
is also included.

Second Year. Second Semester. The principles of immunology are presented
by means of quizzes, conferences and lectures.

The course includes a consideration of infection and immunity, the nature and
action of the various antibodies, complement fixation and flocculation tests, hyper-
sensitiveness, and the preparation of bacterial vaccines.

Experiments are carried out by the class in the laboratory. During the latter
half of the semester the class is divided into sections.

Total hours: Bacteriology 120.
Immunology 72.

Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses oflFered by members of the staff.

DEPARTMENT OF BIOLOGICAL CHEMISTRY

Emx G. ScHMTOT Professor of Biological Chemistry

Glenn S. Weiland Associate Professor of Biological Chemistry

Ann VmcrNiA Brown Instructor in Biological Chemistry

Norma Feik McElvain Research Assistant in Biological Chemistry

Jose A. Alvarez Hitchcock Fellow in Neurological Surgery

First Year. Second Semester. This course is designed to present the prin-
ciples of biological chemistry and to indicate their applications to the clinical
aspects of medicine. The phenomena of living matter and its chief ingredients,
secretions and excretions are discussed in lectures and conferences and examined
experimentally. Training is given in biochemical methods of investigation. Total
hours: 208,

Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.

DEPARTMENT OF PHARMACOLOGY

John C. Krantz, Jr Professor of Pharmacology

C. Jelleff Carr Associate Professor of Pharmacology

Harry K. Iwamoto Assistant Professor of Pharmacology

Ruth Mxjsser Instructor in Pharmacology

Joseph G. Bird Assistant and Fellow in Pharmacology

Stephen Krop Lecturer in Pharmacology

Leonard Karel Lecturer in Pharmacology

William G. Harne Demonstrator in Pharmacology

Frederick K. Bell U. S. Pharmacopoeia Fellow

^To be appointed.

58 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

John B. Harman Emerson Fellow in Pharmacology

Mary J. Sauerwald Emerson Fellow in Pharmacology

Edward B. Truitt, Je Markle Fellow in Pharmacology

G. D. Maengwyn-Davies Fellow in Pharmacology

This course is designed to include those phases of pharmacology necessary for
an intelligent use of drugs in the treatment of disease. The didactic instruction
includes materia medica, pharmacy, prescription-writing, toxicology, posology,
pharmacodjmamics, and experimental therapeutics. The laboratory exercises
parallel the course of lectures.

In addition, optional conference periods and lectures are available for students
desiring further instruction or advice.

Total hours: 216.

Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.

DEPARTMENT OF PATHOLOGY

Hugh R. Spencer Professor of Pathology

Robert B. Wright Associate Professor of Pathology

C. Gardner Warner Associate Professor of Pathology

Walter C. Merkel Associate Professor of Pathology

Albert E. Goldstein Assistant Professor of Pathology

Dexter L. Reimann Assistant Professor of Pathology

John A. Wagner Assistant Professor of Pathology

Howard J. Maldeis Associate in Pathology

Milton S. Sacks Associate in Pathology

Benedict Skitarelic Associate in Pathology

Leon Freedom Associate in Pathology

Conrad B. Acton Instructor in Pathology

Howard B. Mays Instructor in Pathology

Ephraim T. Lisansky Instructor in Pathology

D. McClelland Ddcon Instructor in Pathology

WruiAM B. VandeGrift Instructor in Pathology

William J. Bryson Instructor in Pathology

Karl V. Mech Instructor in Pathology

Seymour W. Rubin Instructor in Pathology

Richard J. Colfer Instructor in Pathology

Robert E. Bauer Assistant in Pathology

Donald E. Fisher Assistant in Pathology

Courses of instruction in pathology are given during the second and third years.
The courses are based on the previous study of normal structure and function and
aim to outline the history of disease. The relationship between clinical s)Tnptoms
and anatomical lesions is constantly stressed.

General Pathology. Second Semester, Second Year. This course includes
the study of disturbances of the body fluids; disturbances of structure, nutrition
and metabolism of ceUs; disturbances of fat, carbohydrate and protein metab-
oUsm; disturbances of pigment metabolism; inflammation and tumors.

Laboratory instruction is based on the study of prepared slides (loan collection)
and corresponding gross material.

Applied Pathology, Including Gross Morbid Anatomy and Morbid
Physiology. Third Year. The laboratory instruction in this course is carried

ORGANIZATION OF TEE CURRICULUM 59

out in small teaching museums where prepared specimens and material from au-
topsies with clinical histories and sections are available for study. For this work
the class is divided into small groups. Clinical correlation is stressed.

Autopsies. Third Year. Students in small groups attend autopsies at the
morgues of the University Hospital and the Baltimore City Hospitals.

Clinical-Pathological Conference. {Fourth Year.) These exercises are
held in collaboration with the Department of Medicine. Selected cases are dis-
cussed and autopsy findings are presented.

Second year 184 hours

Third year 160 hours

Fourth year 30 hours

Total 374 hours

DEPARTMENT OF MEDICINE

Maurice C. Pincoffs Professor of Medicine

G. CAEB.0LL LocKAED Profcssor of Clinical Medicine

Thomas P. Sprunt Professor of Clinical Medicine

H. Raymond Peters Professor of Clinical Medicine

Loxns A. M. Krause Professor of Clinical Medicine

T. Nelson Carey Professor of Clinical Medicine and Chairman of the Department

of Medicine

Paul W. Clough Associate Professor of Medicine

Walter A. Baetjer Associate Professor of Medicine

William S. Love, Jr Associate Professor of Medicine

Thomas C. Wolff Associate Professor of Medicine

Howard M. Bubert Associate Professor of Medicine

J. Sheldon Eastland , Associate Professor of Medicine

MrLTON S. Sacks Associate Professor of Medicine

Lewis P. Gundry Associate Professor of Medicine

Samuel Morrison Associate Professor of Medicine

Theodore E. Woodward Associate Professor of Medicine

William H. Smith Associate Professor of Clinical Medicine

Howard J. Maldeis Associate Professor of Legal Medicine

George McLean Assistant Professor of Medicine

Wetherbee Fort Assistant Professor of Medicine

Frank J. Geraghty Assistant Professor of Medicine

H. Vernon Langeluttig Assistant Professor of Medicine

Sol Smith Assistant Professor of Medicine

Edward F. Cotter Assistant Professor of Medicine

Samuel Legum Associate

Robert A. Reiter Associate

in Medicine
in Medicine

W. Grafton Herspberger Associate in Medicine

Meyer W. Jacobson Associate in Medicine

Conrad B. Acton Associate in Medicine

Irveng Freeman Associate in Medicine

Francis G. Dickey Associate in Medicine

C. Edward Leach Associate in Medicine

Lawrence M. Serra Associate in Medicine

Marie A. Andersch Associate in Medicine

Harry M. Robinson, Jr Associate in Medicine

William K. Waller Associate

Ephraim T. Lisansky Associate

in Medicine
in Medicine

Samuel T. R. Revell Associate in Medicine

60 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Arthur Karpgin Associate in Medicine

M. Paul Byeexy Associate in Medicine

Henry W. D. Holljtes Associate in Medicine

S. Edwin Muller Associate in Medicine

David Tenner Instructor in Medicine

Philip D. Flynn Instructor in Medicine

Edward S. Kallins Instructor in Medicine

John A. Myers Instructor in Medicine

Kurt Levy Instructor in Medicine

William G. Helfrich Instructor in Medicine

M. Paul Padget Instructor in Medicine

Leon Ashman Instructor in Medicine

Joseph E. Muse, Jr Instructor in Medicine

Daniel Wilfson, Jr Instructor in Medicine

William H. Kammer, Jr Instructor in Medicine

Samuel J, Hankin Instructor in Medicine

Frederick J. Vollmer Instructor in Medicine

Louis J. Kroll Instructor in Medicine

John R. Davis Instructor in Medicine

John Z. Bowers® Instructor in Medicine

Wilfred H. Townshend Instructor in Medicine

Alvin J. Hartz Instructor in Medicine

Henry J. Marriott Instructor in Medicine

Morris Fine Assistant in Medicine

Samuel Snyder Assistant in Medicine

Joseph B. Gross Assistant in Medicine

James R. Karns Assistant in Medicine

L. Ann Hellen Assistant in Medicine

Audry M. Funk Assistant in Medicine

RoLLiN C. Hudson Assistant in Medicine

Stephen J. Van Lill, 3rd Assistant in Medicine

Franklin E. Leslie Assistant in Medicine

Thomas L. Worsley Assistant in Medicine

John B. DeHoff Assistant in Medicine

Adam Swiss Assistant in Medicine

John C. Osborne Assistant in Medicine

Edmund G. Beacham Assistant in Medicine

Jerome Cohn Assistant in Medicine

William G. Fusting Assistant in Medicine

Stuart D. Sunday Assistant in Medicine

Jonas Cohen Assistant in Medicine

GENERAL OUTLINE

Second Year
Introduction to clinical medicine.

(a) Introductory physical diagnosis. (1 hour a week, first semester; 2 hours a week,

second semester.)

(b) Medical clinics. (1 hour a week, second semester.)

*0n leave of absence.

ORGANIZATION OF TEE CURRICULUM 61

Third Year

I. The methods of examination (13 hours a week), (a) History taking, (b) Physical
diagnosis, (c) Clinical pathology.
These subjects are taught and practiced in the hospital out-patient department
and in the clinical laboratory.
II. The principles of medicine (200 hours).

(a) Lectures, clinics and demonstrations in general medicine, neurology, pediatrics
psychiatry and preventive medicine.

Fourth Year
The practice of medicine.
I. Clinical clerkship on the medical wards. (26 hours a week for ten weeks.)

(a) Responsibility, under supervision, for the history, ph)rsical examination,

laboratory examinations and progress notes of assigned cases.

(b) Ward classes in general medicine, the medical specialties, and therapeutics.
II. Clinics in general medicine and the medical specialties.

(6 hours a week.)
m. Dispensary work in the medical specialties.
IV. Clinical-pathological conferences (1 hour a week).

MEDICAL DISPENSARY WORK

The medical dispensaries of both the Mercy and the University Hospitals are
utilized for teaching in the third year. Each student spends two hours daily for
ten weeks in dispensary work. The work is done in groups of four to six students
under an instructor. Systematic history-taking is especially stressed. Physical
findings are demonstrated. The student becomes familiar with the commoner
acute and chronic disease processes.

PHYSICAL DIAGNOSIS

T. Conrad Wolit Associate Professor of Medicine, Head of Department

Robert A. Reiter. . . .Associate in Medicine, in charge of Lower Respiratory Disease

Samuel Ledum Associate in Medicine, in charge of Cardiovascular Disease

Irving Freeman Associate in Medicine

Grafton Hersperger Associate in Medicine

Louis Kroll Instructor in Medicine

Daniel Wilfson Instructor in Medicine

Leon Ashman Instructor in Medicine

Joseph Muse Instructor in Medicine

Samuel Hankin Instructor in Medicine

Kurt Levy Instructor in Medicine

Alvin Hartz Instructor in Medicine

William G. Helfrich Instructor in Medicine

John B. DeHoff Assistant in Medicine

Stuart D. Sunday Assistant in Medicine

Thomas L. Worsley, Jr Assistant in Medicine

Jerome Cohn Assistant in Medicine

Elizabeth D. Sherrill Assistant in Medicine

William H. Fusting Assistant in Medicine

62 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

The course in physical diagnosis starts with the first semester of the Sophomore
year and ends with the termination of the second semester of the Junior year.

First Semester — Second Year — Lecture, one hour weekly covering the technique
of history writing in the normal person and the mechanics of the physical signs
elicited in the normal person through inspection, palpation, percussion and aus-
cultation.

Second Semester — Second Year — Lecture, one hour weekly, covering the tech-
nique of history writing in cases involving disease, and the mechanics of patho-
logical physical signs on inspection, palpation, percussion and auscultation.

In the third and fourth quarters small tutorial groups are formed, each under
the direction of an instructor. Experience in physical examination of normal indi-
viduals is given in the third quarter for one afternoon weekly. In the fourth
quarter the students become acquainted with abnormal signs through examination
of hospital patients.

Third Year — a. The class is divided into four sections. Each section receives
bedside instruction in physical diagnosis for seven weeks (2 hrs. daily). For this
purpose small groups under an instructor are formed. The instruction is carried
on in the Baltimore City Hospitals but in addition advantage is occasionally taken
of the clinical opportunities in other institutions.

b. Lecture course (1 hr. weekly) covering the mechanisms of abnormal signs.

THERAPEUTICS

Third Year. General therapeutics and materia medica are taken up and an
effort is made to familiarize the student with the practical treatment of disease.
The special therapy of the chief diseases is then reviewed.

Fourth Year. Special consideration is given to the practical application of
therapeutic principles in bedside teaching and the chief therapeutic methods are
demonstrated.

Students attend therapeutic ward rounds once a week throughout their medical
trimester.

TROPICAL MEDICINE

Certain phases of tropical medicine are considered in the course on clinical
pathology. In addition, a course of lectures and demonstrations is given to the
entire fourth year class.

TUBERCULOSIS

During the third year in connection with the instruction in physical diagnosis
a practical course is given at the Municipal Tuberculosis Hospital. Stress is laid
upon the recognition of the physical signs of the disease, as well as upon its symp-
tomatology and gross pathology.

CARDIOLOGY

In the third year a series of lectures and clinics correlated with pathological
studies is given the entire class.

During the fourth year an elective course in cardiology is offered at the Mercy

ORGANIZATION OF THE CURRICULUM 63

Hospital. The course occupies one and one-half hours weekly. Physical diag-
nosis, electocardiography and the therapeutic management of cardiac cases
are stressed.

Elective out-patient work is available also to members of the fourth year class
in the cardiac clinic of the University Hospital.

SYPHILIS

Third Year. During the third year the subject of syphilis is dealt with in the
lecture course.

Fourth Year. An elective course in the therapeutic management of syphilis is
offered in the dispensary.

CLINICAL PATHOLOGY

Milton S. Sacks Associate Professor of Medicine and Head of

Department of Clinical Pathology

Sol Smith Assistant Professor of Medicine

Marie A. Andersch Biochemist, University Hospital, Associate in Medicine

S. Edwin Muller Associate in Medicine

John A. Wagner Assistant in Medicine

L. Ann Hellen Assistant in Medicine

Audrey M. Funk Assistant in Medicine

George W. Bradford Baltimore Rh Laboratory Fellow in Medicine

Joseph A. Gutlbeau, Jr Baltimore Rh Laboratory FeUow in Obstetrics

Third Year. First and second semesters. The course in Clinical Pathology is
designed to train the student in the third year in the performance and interpretation
of fundamental diagnostic laboratory procedures used in clinical medicine.

During the first semester the work is devoted to a thorough consideration of dis-
eases of the hematopoietic system. In the second semester, in connection with
laborator>' work in urinalysis, gastric analysis, hepatic, pancreatic and renal func-
tions, thorough discussion of underlying biochemical and physiological mecha-
nisms is undertaken. During this semester examination of cerebrospinal fluid,
transudates and exudates is also included. Elements of clinical parasitology
round out the work in this semester.

Each student provides his own microscope and blood counting equipment. A
completely equipped locker is assigned to every student.

Total Hours: 128.

Fourth Year. During the fourth year the student applies in the laboratories of
the various affiliated hospitals the knowledge acquired during the preceding year.
A completely equipped locker is assigned enabling him to work independently of
the general laboratories. Instructors are available during certain hours to give
necessary assistance and advice.

GASTRO-ENTEROLOGY

Theodore H. Morrison Clinical Professor of Gastro-Enterology

Samuel MoioasoN Associate Professor of Gastro-Enterology

Maurice Feldman Assistant Professor of Gastro-Enterology

64 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Zachariah Morgan Assistant Professor of Gastro-Enterology

Francis G. Dickey Associate in Medicine

Z. Vance Hooper Associate in Gastro-Enterology

Albert J. Shochat Instructor in Gastro-Enterology

Alfred S. Lederman Assistant in Gastro-Enterology

Third Year. A series of six lectures is given on the diseases of the digestive
tract.

Fourth Year. Clinics and demonstrations are given to the class for one hour a
week; dispensary instruction to small groups throughout the entire session. Prac-
tical instruction is given in the use of modern methods of study of the diseases of
the gastro-intestinal tract.

PSYCHIATRY

Ross McC. Chapman Professor of Psychiatry

Ralph P. Truitt Professor of Clinical Psychiatry

H. Whitman Newell Associate Professor of Psychiatry

Harry M. Murdock Assistant Professor of Psychiatry

Philip S. Wagner Assistant Professor of Psychiatry

Hans W. Loewald Assistant Professor of Psychiatry

William W. Elgin Assistant Professor of Psychiatry

J. G. N. Gushing Assistant Professor of Psychiatry

Leslie B. Hohman Associate in Psychiatry

Kathryn L. Schultz Associate in Psychiatry

Isadore TtnERK Associate in Psychiatry

A. Russell Anderson Instructor in Psychiatry

Frai^jcis J. McLaughlin Instructor in Psychiatry

Samuel Novey Instructor in Psychiatry

Harold L. Vyner Instructor in Psychiatry

Joseph H. Marshall Instructor in Psychiatry

Richard H. Pembroke, Jr Instructor in Psychiatry

Aaron Podolnick Fellow in Psychiatry

First Year. The 16 lecture hours will be devoted largely to a discussion of
factors influencing the formation of character and the deviations in personality
falling withui the range of "normal." The usual endogenous and environmental
experiences which provide critical periods during the life of an mdividual will be
chronologically presented. Basic psychological concepts and psycho-dynamics
will be reviewed. The methods of psychiatry with reference to the life history,
mental status examination, and psychometric testing will be outlined and
demonstrated.

Second Year. Fourteen 2-hour lecture demonstrations on psychopathology will
introduce the student to personality deviations considered "abnormal." The
mental status examination will be demonstrated in detaU. The major and minor
psychoses will be presented in terms of the psycho-dynamics of symptoms and re-
action types. The student will be expected, at the conclusion of the year, to be
familiar with the psychopathology and clinical characteristics of the usual psy-
chiatric problems.

ORGANIZATION OF TEE CURRICULUM 65

Third Year. The 16 lecture hours will be devoted to further considerations of
special psychopathology and the principles of psychotherapy. Specialized forms
of treatment wUl be reviewed, but the main emphasis will be toward familiarizing
the student with forms of therapy feasible in routine medical practice. During
the 36 clinic hours the student will be supervised in history-taking, mental status
and psychometric examination, and follow-up studies of patients.

Fourth Year. A series of 10 lecture demonstrations wiU serve to summarize
previous instruction and to appraise the student's insight into psychopathology,
the recognition of clinical syndromes, and their management. Characteristic
reaction types will be demonstrated and discussed largely as concerns probable
etiology and possible preventive measures. The relationship of mental iUness to
the major problems of social upheaval, economic, and other sources of insecurity
will be considered.

PEDIATRICS
J. Edmund Bradley . . Associate Professor of Pediatrics and Acting Head of the Department

C. LoEiNG JosLiN Professor of Pediatrics

Edgar B. Friedenwald Professor of Clinical Pediatrics

Harold E. Harrison Associate Professor of Pediatrics

A. H. FiNKELSTEiN Associate Professor of Pediatrics

Frederick B. Smith Associate Clinical Professor of Pediatrics

Albert Japfe Associate Clinical Professor of Pediatrics

Samuel S. Glick Assistant Professor of Pediatrics

Clewell Howell Associate in Pediatrics

G. Bowers Manseorter Associate in Pediatrics

Jerome Fineman Associate in Pediatrics

Gibson J. Wells ' Associate in Pediatrics

Arnold F. Lavenstein Instructor in Pediatrics

Mary L. Hayleck ; Instructor in Pediatrics

Israel P. Meranski Instructor in Pediatrics

William Earl Weeks Assistant in Pediatrics

J. Carlton Wich Assistant in Pediatrics

O. Walter Spurrier Assistant in Pediatrics

Joseph M. Cordi Assistant in Pediatrics

Donald D. Cooper Assistant in Pediatrics

Third Year. The course is presented as follows:

Lectures on infant feeding and the fundamentals of diseases of infants and
children. (15 hours.)

Lectures on contagious diseases in conjunction with the Department of
Hygiene and Preventive Medicine. (14 hours.)

A special course in physical diagnosis is given at City Hospitals. (20 hours.)

Clinical conferences demonstrating diseases of the new-born. (6 hours.)

Fourth Year. An amphitheatre clinic is given at which patients are shown
to demonstrate the features of the diseases discussed. (30 hours.)

Conferences and demonstrations are given in problems concerning diagnosis,
care, treatment and clinical pathology of the diseases of infants and children.
(30 hours.)

66 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Students are assigned subjects for the preparation of theses.

Clinical clerkships are assigned on the pediatric wards, where experience is
gained in taking histories, making physical examinations, doing routine laboratory
work, and following up the patients' progress. This is under the supervision of the
visiting staff. (140 hours.)

Instruction is given in the pediatric clinic of the out-patient department of
the University Hospital. This consists of la hours daily for five weeks — 30
minutes each day being devoted to a clinical demonstration of some interesting
case by a member of the staff; one hour daily to taking histories and making
physical examinations under supervision of one of the staff instructors. (45 hours.)

Total hours: 300.

NEUROLOGY

Andrew C. Gillis Professor of Neurology

Leon Freedom Associate Professor of Neurology

Philip F. Lerner Assistant Professor of Neurology

William L. Fearing Associate in Neurology

Edward F. Cotter Associate in Neurology

Harry Teitelbaxjm Associate in Neurology

Second Year. Fifteen one-hour lectures are given to correlate the anatomy
and physiology of the nervous system with clinical neurology.

Third Year. Twenty hours of instruction are given to the whole class in neuro-
pathology supplemented with pathological demonstrations. Sixteen lecture-
demonstrations are given in which the major types of the diseases of the nervous
system are discussed. A course is also given at the Baltimore City Hospitals,
comprising eight periods of two hours each, in which the students in small groups
carry out complete neurological examinations of selected cases which illustrate
the chief neurological syndromes.

Fourth Year. A clinical conference one hour each week is given to the whole
class at the University and Mercy Hospitals. All patients presented at these
clinics are carefully examined. Complete written records are made by the stu-
dents who demonstrate the patients before the class. The patients are usually
assigned one or two weeks before they are presented, and each student in the class
must study and present one or more patients during the year.

Ward Class Instruction. Nine hours of instruction are given to each student
in small sections at the University and Mercy Hospitals. In these classes the
students come in close personal contact with the patients in the wards under the
supervision of the instructor.

Dispensary Instruction. Small sections are instructed in the dispensaries of
the University and Mercy Hospitals five afternoons each week. In this way
students are brought into contact with nervous diseases in their early and late
manifestations.

HYGIENE AND PUBLIC HEALTH

Huntington Williams Professor of Hygiene and Public Health

William H. F. Warthen Associate Professor of Hygiene and Public Health

ORGANIZATION OF THE CURRICULUM 67

Ross Davies Associate Professor of Hygiene and Public Health

Horace Hodes Associate Professor of Hygiene^ and Public Health

Martha C. Eaton Instructor in Hygiene and Public Health

Third Year. A one-hour lecture is given to the whole class each Tuesday during
both semesters. Basic instruction is afforded in the clinical and public health
aspects of the communicable diseases including s)T)hilis and tuberculosis. The
lectures are under the auspices of the Department of Medicine and are given by
staff members of that department, including physicians representing pediatrics,
hygiene and public health, and by staff members of the Baltimore City Health
Department.

Fourth Year. Elective work is also assigned at Sydenham Hospital, the one-
hundred bed communicable disease hospital of the City Health Department, and
at its Western Health District, 617 West Lombard Street, where the District
Health Officer arranges for home visiting and the student prepares and presents
a Home Survey Report.

The course deals with the fundamentals of public health and supplements the
work in the third year. The major emphasis in both years is on the practice of
preventive medicine and the relation of prevention to diagnosis and treatment,
and on the civic and social implications of the medical services.

LEGAL MEDICINE

Howard J. Maldeis Associate Professor of Legal Medicine

Chief Medical Examiner, Maryland

Third Year. This course embraces a summary of some of the following: Pro-
ceedings in criminal and civU prosecution, medical evidence and testimony, identity
and its general relations, rape, criminal abortions, signs of death, wounds in their
medico-legal relations, natural and homicidal death, malpractice, insanity, and
medico-legal autopsies, including poisoning.

Total hours: 4.

DERMATOLOGY AND SYPHILOLOGY

Harry M. Robinson, Sr Professor of Dermatology

Francis A. Ellis Assistant Professor of Dermatology

Harry M. Robinson, Jr Assistant Professor of Dermatology

Eugene S. Beeeston Associate in Dermatology

A. Albert Shapiro Associate in Dermatology

Israel Zeligman Associate in Dermatology

R. C. V. Robinson Associate in Dermatology

LuciLE J. Caldwell Instructor in Dermatology

Benjamin Highstein Instructor in Dermatology

V. Harwood Link Assistant in Dermatology

Morris M. Cohen Assistant in Dermatology

The third year class receives six lecture-demonstrations on the principles of
dermatology by Dr. Robinson.

68 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

The senior course consists of demonstrations of the common skin diseases and
venereal diseases given throughout the year by Dr. Robinson and staff. A weekly
lecture-demonstration is given to the whole senior class by Dr. Robinson and
Dr. Ellis.

Daily demonstrations and conferences are carried on by the out-patient staff in
the dermatologic clinic involving both skin diseases and venereal diseases.

Third year 15 hours

Fourth Year 49 hours

Total 64 hours

DEPARTMENT OF SURGERY

Charles Reid Edwards Professor of Surgery

Walter D. Wise Professor of Surgery

Elliott H. Hutchins Professor of Surgery

F. L. Jennings Professor of Clinical Surgery

D. J. Pessagno Professor of Clinical Surgery

Monte Edwards Clinical Professor of Surgery

George H. Yeager Clinical Professor of Surgery

Otto C. Brantigan Clinical Professor of Surgery

Harry C. Hull Clinical Professor of Surgery

Charles A. Reifschneider Clinical Professor of Traumatic Surgery

Thomas R. Chambers Associate Professor of Surgery

R. W. Locher Associate Professor of Clinical Surgery

Edward S.Johnson Associate Professor of Surgery

Grant E. Ward Associate Professor of Surgery

Cyrus F. Horine Associate Professor of Surgery

Charles W. Maxson Associate Professor of Surgery

C. W. Peake Associate Professor of Surgery

H. F. Bongardt Assistant Professor of Surgery

I. O. Rldgely ■ Assistant Professor of Surgery

James W. Nelson Assistant Professor of Surgery

I. RiDGEWAY Trimble Assistant Professor of Surgery

Simon H. Brager Assistant Professor of Surgery and Proctology

Thurston R. Adams Assistant Professor of Surgery

W. Wallace Walker Assistant Professor of Surgery

Raymond F. Helfrich Associate in Surgery

William B. Settle Associate in Surgery

Arthur G. Siwinski Associate in Surgery

William F. RiENHOFr, Jr Associate in Surgery

George Govatos Associate in Surgery

Joseph V. Jerardi Associate in Surgery

Henry L. Rigdon Associate in Surgery

Herbert E. Reifschneider Associate in Surgery

Joseph M. Miller Lecturer in Surgery

J. DuER Moores Instructor in Surgery

Calvin Hyman Instructor in Surgery

Clyde F. Karns Instructor in Surgery

Daniel R. Robinson Instructor in Surgery

ORGANIZATION OF TEE CURRICULUM 69

George H. Brouillet Instructor in Surgery

Haiiry C. Bowie Instructor in Surgery

William L. Garlick Instructor in Surgery

Stuart G. Coughlan Instructor in Surgery

Harold H. Burns Instructor in Surgery

John F. Schaefer Instructor in Surgery

Robert F. Healy Instructor in Surgery

Robert C. Sheppard Instructor in Surgery

Samuel E. Proctor Instructor in Surgery

F. Ford Loker Instructor in Surgery

William R. Gehaghty Assistant in Surgery

Howard B. McElwain Assistant in Surgery

A. V. BuCHNEss Assistant in Surgery

T. J. TouHEY Assistant in Surgery

Samuel H, Culver Assistant in Surgery

L. T. Chance Assistant in Surgery

W. Allen Deckert Assistant in Surgery

Patrick C. Phelan, Jr Assistant in Surgery

E. Roderick Shipley Assistant in Surgery

William C. Dunnigan Assistant in Surgery

Howard L. Zupnik Assistant in Surgery

Raymond M. CxrNNiNGHAM Assistant in Surgery

Edwin H. Stewart, Jr Assistant in Surgery

John W. Chambers Assistant in Surgery

Ross Z. Pierpont Assistant in Surgery

Instruction is given by means of lectures, laboratory work, recitations, dis-
pensary work, bedside instruction, ward classes, and clinics. The work begins
in the second year and continues throughout the third and fourth years.

The teaching is done in the anatomical laboratory, operative surgery labora-
tory, the dispensaries, wards, laboratories and operating rooms of the University
and Mercy Hospitals, and in the wards and operating rooms of the Baltimore City
Hospitals.

SECOND YEAR

Topographic and Surgical Anatomy. Second semester. The course is
designed to bridge the gap between anatomy in the abstract and clinical anatomy
as appUed to the study and practice of medicine and surgery.

The teaching is done in the anatomical laboratory, and students are required to
dissect and to demonstrate all points, outlines, and regions on the cadaver. Under-
lying regions are dissected to bring out outlines and relations of structures.

Two lectures and two laboratory periods per week. Drs. Brantigan, Walker,
Settle, Bowie, H. E. Reifschneider, Rigdon, Brouillet and Pierpont.

Total hours: 96.

Principles of Surgery. Second semester. This course includes discussions
of irritants, infection, repair of tissue, healing of tissue, relationship of bacteriology
to surgery, modem chemotherapy in surgical diseases, ulcers, wounds, thrombo-
phlebitis, phlebothrombosis, peripheral vascular diseases, thermal burns, injuries
due to cold, surgical shock, diseases of the lymphatics, gangrene of the skin and

70 THE SCHOOL OP MEDICINE, UNIVERSITY OF MARYLAND

extremities, aneurysms, hemorrhage, varicose veins, embolism, sinuses and fistulae,
tetanus, anthrax and actinomycosis.

Lectures, two hours a week for one semester, are given to the whole class. Drs.
Adams and Sheppard.

THIRD YEAR

General and Regional Surgery. Lectures, recitations and clinics on the
principles of surgery, general surgery including fractures and dislocations are
given three hours a week to the whole class. Dr. Hull.

The class is divided into groups and receives instruction in history-taking
and surgical pathology under the supervision of the chief of the pathologic
department of the Baltimore City Hospitals. Instruction is also given in surgi-
cal diagnosis and in general surgery at the bedside and in the classroom at this in-
stitution by Drs. Hull, C. A. Reifschneider, Brantigan and Adams. Two hours
per week are given in orthopaedic surgery by Dr. VosheU, chief of the orthopaedic
service of this institution.

Operative Surgery. Two courses in operative surgery are given under the
supervision of Dr. Yeager assisted by Drs. Ullrich, Peake, Brager, Mays, Govatos
Jerardi, Karns, Daniel R. Robinson, Healy, Deckert and E. R. Shipley. The class
is divided into sections and each section is given practical and individual work
under the supervision of the instructors.

Surgical Out-patient Department. Under supervision, the student takes
the history, makes the physical examination, attempts the diagnosis and, as far
as possible, carries out the treatment of ambulatory surgical patients in the
University and Mercy Hospitals. Mercy Hospital — Dr. Raymond F. HeKrich
assisted by the out-patient staff . University Hospital — Drs. Settle and Sheppard
assisted by the out-patient staff.

FOURTH YEAR

Clinics. A weekly clinic is given at the Mercy and at the University Hospitals
to one-half the class throughout the year. As far as possible this is a diagnostic
clinic. Mercy Hospital — Dr. Wise. University Hospital — Dr. C. R. Edwards.

Surgical Pathology. At Mercy Hospital. Specimens from the operating
room and museum are studied in the gross and microscopically in relation to the
case history. 14 hours. Dr. Pessagno.

Surgery of the Chest. At Mercy Hospital. Operations and conferences.
14 hours. Drs. Rienhoff and Garlick.

Traumatic Surgery. This course deals with operative and post-operative
treatment of accident cases and with instructions as to the relationship between the
state, the employee, the employer, and the physician's duty to each. One hour
a week to sections of the class throughout the year. Dr. C. A. Reifschneider.

Clinical Clerkship. This work includes the personal study of assigned
hospital patients, under supervision of the staffs of the University and Mercy
Hospitals, and embraces history-taking, and physical examination of patients,
laboratory examinations, attendance at operations and observation of post-
operative treatment.

ORGANIZATION OF THE CURRICULUM 71

Ward Classes. Ward-class instruction in small groups will consist of ward
rounds, surgical diagnosis, treatment and the after-care of operative cases. Mercy
Hospital — Drs. Wise, Hutchins, Blake, Pessagno, Nelson, Trimble, Brager and
Jerardi. University Hospital — Drs. C. Reid Edwards, Yeager, Hull and C. A.
Reifschneider.

ORTHOPAEDIC SURGERY

Allen Fiske Voshell Professor of Orthopaedic Surgery

Harsy L. Rogers Clinical Professor of Orthopaedic Surgery

Moses Gellman Associate Professor of Orthopaedic Surgery

Henry F. Ullrich Associate Professor of Orthopaedic Surgery

I. H. Maseritz Associate in Orthopaedic Surgery

Milton J. Wilder Associate in Orthopaedic Surgery

Jason H. Gaskel Instructor in Orthopaedic Surgery

Didactic, clinical, bedside and out-patient instruction is given in the fourth
year at the University and Mercy Hospitals and Dispensaries, Keman Hospital
for Crippled Children at DickeyvUle and Baltimore City Hospitals. Instruction
is also given in the third year in small groups at the Baltimore City Hospitals.

Weekly lectures throughout the year present all phases of orthopaedic surgery
except fractures; brief discussions and demonstration of physical and occupational
therapy are included.

Fourth year groups are given more intimate instruction biweekly at one of the
above institutions; fracture cases are included here.

Third year 60 hours

Fourth year 90 hours

Total 150 hours

rhinology and laryngology

Edward A. Looper Professor of Rhinology and Laryngology

Waitman F. Zinn Clinical Professor of Rhinology and Laryngology

Franklin B. Anderson Associate Professor of Rhinology and Laryngology

Thomas R. O'Rourk Associate Professor of Rhinology and Laryngology

Benjamin S. Rich Associate Professor of Rhinology and Laryngology

W. Raymond McKenzie Associate in Rhinology and Laryngology

Fayne a. Kayser Associate in Rhinology and Laryngology

Theodore A. Schwartz Associate in Rhinology and Laryngology

Frederick T. Kyper Associate in Rhinology and Laryngology

Samuel L. Fox Associate in Rhinology and Laryngology

Benjamin H. Isaacs Instructor in Rhinology and Laryngology

Robert Z. Berry Assistant in Rhinology and Laryngology

John H. HmscHTELD Assistant in Rhinology and Laryngology

Third Year. Instruction to whole class is given in the common diseases of the
nose and throat, attention being especially directed to infections of the accessory
sinuses, the importance of focal infections in the etiology of general diseases and

72 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

modern methods of diagnosis. Lectures illustrated by lantern slides are given
one hour weekly for seven weeks by Dr. Looper.

Fourth Year. Dispensary instruction is given for one and one-half hours dailj',
to small sections at the University and the Mercy Hospitals. The student is
afiforded an opportunity to study, diagnose and treat patients under supervision.
Ward classes and clinical demonstrations are given in periods of one and one-half
hours weekly throughout the session in the University and the Mercy Hospitals.

The Looper Clinic for bronchoscopy and esophagoscopy, recently established
in the University Hospital, affords unusual opportunities for students to stud)^
diseases of the larjoix, bronchi and esophagus. The clinic is open to students
daily from 2 to 4 P.M. under direction of Dr. Looper.

The Mercy Hospital clinic for bronchoscopy and esophagoscopy is under the
direction of Dr. Zinn. La these two clinics the etiology, symptomatology, diag-
nosis and treatment of foreign bodies in the air and food passages, as well as
bronchoscopy, are taught to students as an aid in the diagnosis and treatment of
diseases of the lungs.

Third year 9 hours

Fourth year 53 hours

Total 62 hours

GENITO-URINARY SURGERY

W. Houston Toulson Professor of Genito-Urinary Surgery

Kenneth D. Legge Professor of Clinical Genito-Urinary Surgery

Howard B. Mays Assistant Professor of Genito-Urinary Surgery

Francis W. Gillis Assistant Professor of Genito-Urinary Surgary

Austin H. Wood Associate in Genito-Urinary Surgery

Lyle J. MiLLAN Associate in Genito-Urinary Surgerj'

L. K. Fargo Associate in Genito-Urinary Surgery

John F. Hogan Associate in Genito-Urinary Surgery

W. A. H. Councill * Associate in Genito-Urinary Surgery

Hugh Jewett Assistant ru Genito-Urinary Surgery

Morris A. Fine Assistant in Genito-Urinary Surgery

John S. Haines Assistant in Genito-Urinary Surgery

Third Year. This course is given for seven hours to the whole class. It con-
sists of lectures and demonstrations, including the use of lantern slides and motion
pictures. Dr. Toulson.

Fourth Year. The course in this year includes explanations and demonstrations
of urethroscopy, cystoscopy, ureteral catheterization, renal function tests, urog-
raphy, urine cultures and the various laboratory procedures. The teaching con-
sists of clinics and ward rounds to small groups, and attendance by members of
the senior class upon the out-patients in the dispensary. The student here is
placed much on his own responsibility in arriving at a diagnosis. Members of
the staff are in constant attendance for consultations. These dispensary classes
are conducted at both the Mercy and University Hospitals where practically
every variety of urogenital disease is seen and used for teaching purposes.

Third year 8 hours

Fourth year 64 hours

Total 72 hours

ORGANIZATION OF THE CURRICULUM 73

PROCTOLOGY

Monte Edwards Professor of Proctology

Thurston R. Adams Assistant Professor of Proctology

Simon H. Brager Assistant Professor of Proctology

Donald B. Hebb Assistant in Proctology

William T. Supik Assistant in Proctology

Raymond M. Cunningham Assistant in Proctology

Third Year. Seven lectures are given to the whole class. This course is for
instruction in the diseases of the colon, sigmoid flexure, rectum and anus, and
covers the essential features of the anatomy and physiology of the large intestine
as well as the various diseases to which it is subject. Dr. Monte Edwards.

Fourth Year. Ward and dispensary instruction is given in the University and
Mercy Hospitals, where different phases of the various diseases are taught by
direct observation and examination. The use of the proctoscope and sigmoido-
scope in the examination of the rectum and sigmoid is made familiar to each stu-
dent. Mercy Hospital — Drs. Blake and Brager. University Hospital — Drs.
Monte Edwards and Adams.

Third year 7 hours

Fourth year 16 hours

Total 23 hours

OTOLOGY

Thomas R. O'Rourk Clinical Professor of Otology

Franklin B. Anderson Associate Professor of Otology

Benjamin S. Rich ; Associate in Otology

Frederick T. Kyper Associate in Otology

Samuel L. Fox Associate in Otology

William A. Parr Instructor in Otology

The course in otology is planned to give a practical knowledge of the anatomy
and physiology of the ear, and its proximity and relationship to the brain and other
vital structures. The inflammatory diseases, their etiology, diagnosis, treatment
and complications are particularly stressed, with emphasis upon their relationship
to the diseases of children, head-surgery and neurology.

Third Year. The whole class is given instruction by means of talks, anatomical
specimens and lantern slides.

Fourth Year. Small sections of the class receive instruction and make personal
examinations of patients under the direction of an instructor. The student is
urged to make a routine examination of the ear in his ward work in general medi-
cine and surger3^

Third year 12 hours

Fourth year 40 hours

Total 52 hours

NEUROLOGICAL SURGERY

Charles Bagley, Jr Professor of Neurological Surgery

Richard G. Coblentz Clinical Professor of Neurological Surgery

74 THE SCHOOL OF MEDICINE, UNIVERSITY OP MARYLAND

James G. Arnold, Jr Associate Professor of Neurological Surgery

John A. Wagner Assistant Professor of Pathology and Neuropathology

Raymond K. Thompson Assistant in Neurological Surgery

Frank J. Otenasek Assistant in Neurological Surgery

John W. Chambers Assistant in Neurological Surgery

Robert M. N. Crosby Fellow in Neurological Surgery

Jose A. Alvarez Hitchcock Fellow in Neurological Surgery

Third Year. The course covers instruction in diagnosis and treatment of
surgical conditions of the brain, spinal cord and the peripheral nerves, Drs.

Bagle}', Coblentz, Arnold and Thompson.

Fourth Year. Weekly ward rounds and conferences are given at the University
Hospital. Drs. Bagley, Coblentz, Arnold and Thompson.

Third year 12 hours

Fourth year 30 hours

Total 42 hours

ONCOLOGY

J. Mason Hundley, Jr Professor of Gynecology

Grant E. Ward Associate Professor of Surgery

Beverley C. Compton Associate in Gynecology

John C. Dumler Associate in Gynecology

Arthur G. Sfwinski Associate in Surgery

J. DuER MooRES Instructor in Surgery

Ernest I. Cornbrooks, Jr Instructor in Gynecology

Welllam K. Diehl Instructor in Gynecology

Everett S, Diggs Assistant in Gynecology

Robert G. Chambers National Cancer Institute Trainee

Marvin Lacy National Cancer Institute Trainee

The purpose of the courses in Oncology is to give students training in the
diagnosis and treatment of neoplastic diseases not obtained in other departments
and at the same time to correlate this training with that received in surgery,
medicine, roentgenology and other specialties.

Third Year: An out-patient clinic is held twice weekly, which aflfords an op-
portunity for instruction in small groups of students assigned in rotation from
the general surgical and gynecological sections. The gynecological problems are
under the supervision of Dr. Hundley and the general surgical conditions are
under the direction of Dr. Ward.

In addition to dispensary work, five lectures in general oncology are given
by Dr. Ward to the entire class at the end of the year. The increasing impor-
tance of the cancer problem throughout the State, Nation and civilized world
is emphasized. The biological aspects of cancer and the relation of hormones,
carcinogenic agents, and etiological factors are reviewed. The histological classifi-
cations and gradation of neoplasms are outlined and the biophysical effects of
irradiation therapy discussed. The diagnosis, surgical and radiological treatment
of neoplasms of the head and neck, oral cavity, skin, breasts, and hemopoietic
system are also discussed. Physics and practical application of radium is given.

ORGANIZATION OF THE CURRICULUM 75

'The diagnosis and treatment, both surgical and radiological, of neoplasms of the
head and neck, oral cavity, skin, breasts and hemopoietic system are also covered.

Fourth Year: Each ward class meets for one and one-half hours once a week
for five weeks with Dr. Ward and staff for demonstration and discussion of pa-
tients with neoplastic diseases.

Dr. Hundley and staff give instructions in the diagnosis and treatment of
•cancer of the generative organs during the regular gynecological courses in ad-
dition to the above mentioned dispensary instruction.

Third year 8 hours

Fourth year 16 hours

Total 24 hours

DENTISTRY

^Bkice M. Dorsey Professor of Oral Surgery

iMyeon S. Aisenberg Professor of Pathology

^George M. Anderson Professor of Orthodontics

Harry M. Robinson, Sr Professor of Dermatology

^Grayson W. Gaver Professor of Dental Prosthesis

^William E. Hahn Professor of Anatomy

^Ernest B. Nuttall Professor of Crown and Bridge

^Kenneth V. Randolph Professor of Operative Dentistry

George H. Yeager Clinical Professor of Surgery

^Edward C. Dobbs Assistant Professor of Pharmacology

Grant E. Ward Associate Professor of Surgery and Oral Surgery

^Joseph C. BmDix, Jr Assistant Professor of Clinical Operative Dentistry

^HuGH T. Hicks : Assistant Professor of Periodontology

George McLean Assistant Professor of Medicine

^Lewis C. Toomey Assistant Professor of Oral Surgery

^Samuel H. Bryant Instructor in Oral Diagnosis

^Russell Gigliotti Instructor in Clinical Oral Diagnosis

^Eugene L. Pessagno Instructor in Operative Dentistry

^Harry B. McCarthy Director of Dental Clinic

This section has been reorganized for the teaching of both medical and dental
students. There has been established a division in the out-patient department,
and beds will be provided in the University Hospital, for the care of patients who
will be available for the teaching of students from both schools.

Senior year: clinics weekly.

Ward instruction and group teaching are given. This includes diagnosis and
treatment of diseases of the face, mouth and jaws.

INDUSTRIAL MEDICINE AND SURGERY

G. Carroll Lockard Professor of Clinical Medicine

Charles A. Reifschneidek Clinical Professor of Traumatic Surgery

Thurston R. Adams Assistant Professor of Surgery

1 Faculty Member, School of Dentistry.

76 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

This section is under the combined supervision of the medical and surgical
departments. It is a cooperative effort by members of the medical school and
hospital staff to afford means for clinical and laboratory study of the patient who
has been subjected to traumatic or medical industrial hazard, so that adequate
care may be instituted to promote his physical well-being. The facihties of the
laboratories of the medical school and hospital are available as required.

Under direction of this department limited undergraduate instruction is given,
especially in the methods of examination and of keeping records and in the general
medico-legal principles as they affect the industrial employee, the employer, the
general insurers, the physician and the hospital. There is also instruction on
methods of making life insurance and other physical examinations, whether for
employment or for health purposes. The wards of the University, Mercy and
Baltimore City Hospitals provide for bed-side instruction.

Total hours: 48.

FIRST AID INSTRUCTION

Instruction consists of lectures combined with practical demonstrations and
actual practice by students for one hour a week for ten weeks during the second
semester of the Freshman Year.

PLASTIC SURGERY

Edward A. Kitlowski Clinical Professor of Plastic Surgery

Clarence P. Scarborough Instructor in Plastic Surgery

Ernest E. Banfield Assistant in Plastic Surgery

Robert G. Chambers Assistant in Plastic Surgery

Mar\t[n Lacy Assistant in Plastic Surgery

This course is designed to acquaint students with the problems of reconstruc-
tive and plastic surgery. A subdivision in the dispensary has been established
and beds for patients will be available for instruction in this course at the Univer-
sity and Baltimore City Hospitals and Keman's Hospital for Crippled Children.

Third Year. Five lectures are given to the whole class. Dispensary instruction
is provided on Mondays and Fridays.

Fourth Year. Ward rounds and operative demonstrations are held at the
hospitals.

DEPARTMENT OF OBSTETRICS

Louis H. Douglass Professor of Obstetrics

Emil Novak Associate Professor of Obstetrics

J. G. M. Reese Associate Professor of Obstetrics

M. Alexander Novey Assistant Professor of Obstetrics

Isadore a. Siegel Assistant Professor of Obstetrics

Jomsr E. Savage Assistant Professor of Obstetrics

Margaret B. Ballard Associate in Obstetrics

Hugh B. McNally Associate in Obstetrics

D. McClelland Dixon Associate in Obstetrics

D. Frank KAXTREmER Associate in Obstetrics

ORGANIZATION OF TEE CURRICULUM 77

Frank K. MoRius Instructor in Obstetrics

Kenneth B. Boyd Assistant in Obstetrics

Thomas S. Bowyer Assistant in Obstetrics

W. Kenneth Manseield, Jr Assistant in Obstetrics

George H. Davis Assistant in Obstetrics

Charles H. Doeller, Jr Assistant in Obstetrics

J. Kjng B. E. Seegar, Jr Assistant in Obstetrics

Schuyler G. Kohn Assistant in Obstetrics

John H. Morrison Assistant in Obstetrics

William A. Mitchell Assistant in Obstetrics

L. CALvm Gareis Assistant in Obstetiics

Clarence W. Martin Assistant in Obstetrics

Third Year. The lectures and recitations consisting of three hours' teaching
weekly are designed to cover the anatomy of the female generative tract and the
bony pelvis, the physiology and development of the ovum and the physiology of
pregnancy and labor. Following this the pathology of pregnancy, labor and the
puerperium are taken up. Drs. Douglass, Reese, Siegel, Savage, and Dixon.

Each student spends time during his junior year at the Baltimore City Hospitals
observing, assisting and finally delivering patients under strict supervision. Each
student sees about twenty deliveries there, and does a considerable amount of the
routine work.

The junior students are assigned as assistants to the seniors in the home delivery
service and accompany them on deliveries.

Each student receives, in small groups, ten hours of instruction in palpation of
patients and mensuration of the pelvis and demonstrations of the mechanism of
labor. Drs. Siegel and McNally.

Fourth Year. At the weekly clinical conference, cases are presented and dis-
cussed and the student body is encouraged to offer opinions and to ask questions.
There is no didactic teaching done, and an earnest effort is made to keep it, in
every sense of the word, a conference. Dr. Douglass and associates.

The ward classes are held twice weekly for five weeks for each group. Various
subjects are assigned and discussed, patients and their histories are presented.
Drs. Reese, Novey, Savage and McNally.

Manikin instruction is given once a week. Drs. Dixon, Kaltreider and Doeller.

During the same five-week period, the students are sent into patients' homes
to conduct deliveries under supervision of a senior member of the house staff and
with the assistance of a graduate nurse. The student is held responsible for the
complete conduct of each assigned case.

Each student spends thirty hours in the prenatal clinic, taking histories and
examining patients under supervision.

Finally, the students are invited to attend the monthly meetings of The Com-
mittee on Maternal Mortality, where all maternal deaths occurring in Baltimore
are openly discussed. Hours — Third year — 148; Fourth year — 102; total — 250.

DEPARTMENT OF GYNECOLOGY

J. Mason Hundley, Jr Professor of Gjmecology

Thomas K. Galvin Clmical Professor of Gynecology

Leo Brady Assistant Professor of Gynecology

78 THE SCHOOL OP MEDICINE, UNIVERSITY OF MARYLAND

Edward P. Smith Assistant Professor of Gynecology

John T. Hibbitts Associate in Gynecology

Kenneth B. Boyd Associate in Gynecology

John C. Dumler Associate in Gynecology

Beverley C. Compton Associate in Gynecology

J. J. Erwin Associate in Gynecology

Frank K. Morris Associate in Gynecology

Ernest I. Cornbrooks, Jr Associate in Gynecology

Everett S. Diggs Associate in Gynecology

William K. Diehl Associate in Gynecology

Thomas S. Bowyer Instructor in Gynecology

Ernest S. Edlow Instructor in G)Tiecology

W. Allen Deckert Instructor in Genecology

H. L. Granoff Assistant in Gynecology

Charles B. Marek Assistant in Gynecology

Helen I. Maginnis Assistant in Gynecology

Charles H. Doeller, Jr Assistant in Gynecology

William A. Dodd Assistant in Gynecology

Harry McB. Beck Assistant in Gynecology

William C. Duffy Assistant in Gynecology

Joseph C. Sheehan Assistant in Gynecology

William J. Rysai«;k Assistant in Gynecology

Harry F. Kane Assistant in Gynecology

Robert B. Tunney Assistant in Gynecology

Theodore Kardash Assistant in Gynecology

William A. Mitchell Assistant in Gynecology

Third Year. A course of thirty lectures and recitations is given to the whole
class. In addition, a short course of lecture-demonstrations is given at the Balti-
more City Hospitals, consisting of eight periods of one hour each, in which small
groups of students are instructed in the fundamentals of gjoiecological diagnosis
and examination.

Fourth Year. Operative clinics — ^lectures and demonstrations — are given six
hours per week, for five weeks, to sections of the class.

Instruction in female urology is given. A small number of students may at-
tend the cystoscopic dispensary which is held twice weekly.

The course in gynecology also includes instruction in the diagnosis and treat-
ment of cancer of the generative organs. Small groups of students attend the
oncological dispensary for additional work.

Third year 38 hours

Fourth year 74 hours

Total 112 hours

DEPARTMENT OF OPHTHALMOLOGY

F. Edwin Knowles, Jr.

Assistant Professor of Ophthalmology and Chairman of the Department

H. K. Fleck Clinical Professor of Ophthalmology

Jonas Feiedenwald Lecturer in Ophthalmic Pathology

ORGANIZATION OF THE CURRICULUM 79

Joseph I. Kemlee Associate in Ophthalmology

F. Edwin Knowles, Je Associate in Ophthalmology

Paul N. Friedman Instructor in Ophthalmology

A. Kremen Instructor in Ophthalmology

Cleo D. Stiles Instructor in Ophthalmology

Ruby A. Smith Instructor in Ophthalmology

Fkederick M. Reese Assistant in Ophthalmology

Third Year. Second semester. Dr. Friedman reviews the anatomy and physi-
ology of the eye and discusses the methods used in making the various exami-
nations. Errors of refraction and their effect upon the general system are explained.
Weekly section work, demonstrating the use of the ophthalmoscope, is carried on
during the entire session.

Fourth Year. Clinics and demonstrations are given in diseases of the eye,
weekly, for one year. Dr. Knowles.

This course consists of lectures upon the diseases of the eye, with particular
reference to their diagnosis and relation to general medicine. Special lectures
will be given upon vascular changes in the eye and upon the pathology of the eye.
Some operations wiU be demonstrated by motion pictures.

Weekly ward classes are held at the University, The Baltimore Eye, Ear and
Throat and Mercy Hospitals during which the eye grounds in the various medical
and surgical conditions are demonstrated. Also daily demonstrations are given
in the taking of histories and the diagnosis and treatment of the various conditions
as seen in the dispensary. Drs. Knowles, Kemler and Kremen.

Third year 20 hours

Fourth year 104 hours

Total 124 hours

DEPARTMENT OF ROENTGENOLOGY

Walter L. Kilby Professor of Roentgenology

Charles N. Davtoson Associate Professor of Roentgenology

Asa D. Young Assistant Professor of Roentgenology

Stanley H. Macht Assistant Professor of Roentgenology

Donald J. Barnett Associate in Roentgenology

Edwin L. Seigman Fellow in Roentgenology

During the academic year, small groups of the third and fourth year classes are
given weekly instruction in the diagnostic and therapeutic uses of the Roentgen
raj^s. An effort is made to familiarize the student with the indications for and the
limitations of the Roentgen ray examinations. The history, physics and practical
therapeutic application of Roentgen rays are given stressing the use of radiation
as a weapon now available in a variety of disorders of the human body ranging from
simple inflammations to malignant neoplastic conditions. Conferences are held
with the various departments during the school year which are also open to mem-
bers of the fourth year class.

Third year S hours

Fourth year 22 hours

Total 30 hours

80 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

DEPARTMENT OF ANAESTHESIOLOGY

Alpred T. Nelson Assistant Professor of Anaesthesiology

and Chairman of the Department
J.^MES Russo Assistant in Anaesthesiology

THIRD YEAR

Lectures are given on the general physiology and pharmacologjr of anesthesia,
with consideration of the special physiology and pharmacology of each anaesthetic
agent. The methods of induction and administration of anaesthesia are discussed.
The factors influencing the selection of the anaesthetic are emphasized, and the
preparation and care of the anaesthetized patient are carefully explained.

These lectures are correlated with practical demonstrations, supplemented by
lantern slides and motion pictures, at the University Hospital.

FOURTH YEAR

Each senior student is required to spend two hours daily for two weeks observing
and administering anaesthetics in the operating suite.

Third year 10 hours

Fourth year 24 hours

Total 34 hours

HISTORY OF MEDICINE
Louis A. M. Krause Associate Professor of Medicine

Beginning with the sprmg of 1942 a group of lectures on the history of medicine
has been presented on selected phases and trends of the development of medical
knowledge and practice. It is planned to avoid duplication of subject matter
for at least four years.

These lectures are offered primarily for our students, but a cordial invitation
is extended to anyone who may wish to attend.

Announcement of the lectures Avill be made by mail and on the bulletin
board of the School of Medicine.

ART AS APPLIED TO MEDICINE

Carl Damje Clarke Associate Professor of .\rt as Applied to Medicine

Frances M. Blackburn .Assistant in Art as Applied to Medicine

Richard Do\\'ell Grill Assistant in Art as Applied to Medicine

Nancy Jant; Fernevhough Assistant in Art as Applied to Medicine

Carl Christian Stein Assistant in Art as Applied to Medicine

This department is maintained for the purpose of supplying pictorial and plastic
illustrations for visual teaching in the classrooms of the medical school and for
publication in scientific periodicals.

Special courses of instruction are given to qualified students.

ORGANIZATION OF THE CURRICULUM 81

POSTGRADUATE COURSES
Committee on Postgraduate Studies

Howard M. Bubert, Chairman John C. Krantz, Jr.

DiETRiai C. Smith, 1st Vice-chairman Eduard Uhlenhuth

L. A. M. Krause, 2nd Vice-chairman Allen F. Voshell

Milton S. Sacks, Secretary J. M. Reese

John A. Wagner Ralph P. Truitt

Otto C. Brantigan Wetherbee Fort

The Dean — Ex Officio

During the past year emphasis was laid upon extra mural teaching in accordance
with the existing trend throughout the country.

A sub-committee under the chairmanship of Dr. Allen F. VosheU arranged for
three courses to be given for county physicians. Requests for courses from other
county societies could not be granted for the present because of the limited resources
of the Committee and its unfamiliarity with the field into which it was entering.
One course was given at the Prince George's County General Hospital at Cheverly,
Maryland; one at the Washington County Hospital at Hagerstown; and one for
the Carroll-Howard County Societies, at the University Hospital. About one
hundred physicians, approximately one seventh of all the county physicians in the
state, participated. A questionnaire distributed upon the completion of the lec-
tures indicated that the venture was a success. The Committee looks forward to
an even larger enrollment for the coming year The lectures are being recorded
and will be distributed to all attending physicians. The Conmiittee hopes to be
able to continue to make this material available.

A long-term plan to integrate the training of the house stafifs of smaller hospitals
with that of the University is being formulated.

The following intra mural courses, which have been most successful, are
continuing:

General Anatomy "A": This course is designed to prepare candidates for the
anatomy examination of the American Board of General Surgery and Surgical
Specialties. There is no hard and fast rule about either the content or duration
of the course. Students may dissect a complete cadaver or any particular region
in which they may be interested. Tuition arranged according to course content.

Surgical Anatomy "B": This course is designed to prepare candidates for the
examination in Anatomy of the American Board of Surgery. This is a ninet}^-hour
course (2 days a week, 3 hours a day) given in conjunction with the regular soph-
omore medical course in surgical anatomy. Tuition 1150.00.

Pathology (neurological) : This course is designed to aid in meeting the re-
quirements of the specialty boards in neurological sciences and covers basic studies
in diseases of the central nervous system. Duration is six months, full time.
Tuition: $200.00 plus $10.00 laboratory fee.

82 THE SCHOOL OP MEDICINE, UNIVERSITY OF MARYLAND

Gynecology and Obstetrics "A": This is a review for general practitioners.
Duration is eighteen hours each of gynecology and obstetrics per week for twelve
weeks. Tuition: $150.00.

Gynecology, Oncology and Female Urology "B": This is a review designed
primarily for the general practitioner. Duration is ten weeks, full time. Tuition
$125.00.

A course in Basic Sciences as They Apply to Gynecology and Obstetrics
is being inaugurated in October, 1948. This course is a review of the fundamentals
of the basic sciences as they apply to Gynecology and Obstetrics and recent ad-
vances in these fields. This course has been approved by the Post Graduate
Survey Committee of the American Board of Obstetrics and Gynecology, and may
be presented for six months' credit towards certification by the Board. Duration
is 20 weeks full time; tuition: $300.00.

Full descriptions of these courses are available.

Inquiries should be addressed to the Post Graduate Committee, University of
Maryland School of Medicine, Baltimore 1, Maryland.

ORGANIZATION OF THE CURRICULUM

FIRST YEAR SCHEDULE
FIRST SEMESTER, SEPTEMBER 16, 1948 TO JANUARY 22, 1949

Hours

1
Monday ] Tuesday

Wednesday

Thursday

Friday

Saturday

9.00

to
12.00

•Histology and

Embryology

11-12 lecture

Bresslc i

Orientation
(Sept. 22-Oct. 6)

9-10

Adm. 1

•Histology and

Embryology

11-12 lecture

Bressler 2

Gross Anatomy
A. H. 9-11

12.00
to
1.00

Lunch

1.00

5.00

Gross Anatomy
Lectures AM. (1-2) Daily and Laboratories Bressler 1 (2-5) Daily

• Course ends December 22, 1948.

SECOND SEMESTER, JANUARY 24 TO JUNE 4, 1949

Hours

Monday

Tuesday

Wednesday

Thursday

Friday '

Saturday

Laboratory

Neuro-Anatomy
Laboratory

9.00

to
12.00

Biol. Chem.

Sect. A

Sect. B

Sect. A

Sect. B

12.00
to

Lunch

1.00

Biol. Chem.

to
2.00

Aim. 1

Adm. 1

Adm.l

2.00

3.00

Neuro-
physiology
BressUr 2

Neuro-
physiology
Bressler 2

Biol. Chem.

Conference

Adm. I

Gross
Anatomy
Adm. 1
Feb. 10

to
Mar. 31

Biol. Chem.

Conference

Adm.l

3.00

Gross
Anatomy

Adm. 1

Psychiatry
(3-5)
C.H.

(3-4)

First Aid

C. H.

to
5.00

Feb. 8

to
Apr. 5

Neuro-Anatomy

Apr. IS

Laboratory

January 28
to April 1

Locations of Lecture Halls and Laboratories:
Adm. 1 — First Floor, Administration Building, Lombard and Greene Streets.
A. H. — Anatomical Hall — Upper Hall, N. E. Cor. Lombard and Greene Streets.
C. H. — Chemical Hall, Lower Hall, N. E. Cor. Lombard and Greene Streets.
Biological Chemistry Laboratory — Third Floor, 31 South Greene Street.
Bressler Research Laboratory— 29 S. Greene Street.
Gross Anatomy — First Floor.
BUstology and Embryology— Second Floor.
Neuro-anatomy — Second Floor .

Mid-Year Examinations— January 17-22, 1949
Final ExaminaHans—May 2J-28, 1949

SECOND YEAR SCHEDULE

FIRST SEMESTER, SEPTEMBER 16, 1948 TO JANUARY 22, 1949

Hours

Monday

Tuesday

■Wednesday

Thursday

Friday

Saturday

8.30
9.30

Physiology
Bressler Z

Physiology
Bressler 2

Medicine
Bressler 2

Physiology
Bressler 2

Psychiatry

9.30

10.30

Physiology
Conference
Bressler 2

Bacteriology
Adm. 1

Pharmacology
Bressler 2

(9-11)
Adm. I

10.30

to
12.30

tBacteriology
Laboratory

Neurological

Diagnosis

C.H.

12.30

Lunch

1.00

5.00

Pharm. Lect. (1-2) Bressler 2

Pharmacology Laboratory

B i A

Physiology Laboratory

A i B

Pharmacology Laboratory

(1 to 4)

B \ A

Physiology Laboratory

A 1 B

t Bacteriology Laboratory — Section work during the last month.

SECOND SEMESTER, JANUARY 24 TO JUNE 4, 1949

Hours

Monday

Tuesday Wednesday

Thursday

Friday

Saturday

8.30

to
9.30

Surgery
Bressler 2

Surgery
BressUr 2

Surgical
Anatomy
Bressler 2

Medical Clinic
Amp.

Physical
Diagnosis

Adm. 1
7 lectures

9.30

to
10.30

Pharmacology
Bressler 2

Pharmacology
BressUr 2

Surgical
Anatomy
Laboratory

Bressler 1

Pharmacology
Bressler 2

10.30
to

11.30

Pathology

c.n.

Pathology
C.H.

Patholog>'
C.H.

Pathology
C.H.

11.30

Lunch

12.00
to

2.00

Pathology
Laboratory

Immunology
Laboratory

Pathology
Laboratory

2.00

to
3.00

Surgical

Anatomy

Adm.l

11 Immunology
Laboratory

Pharmacology

Laboratory

Sect. A

Physical

Diagnosis

Sect. B

(3.00-5.00)

U. H. D.

Pharmacology

Laboratory

Sect. B

Physical
Diagnosis

Sect. A

(3.00-5.00)

U. E. D.

3.00
to

5.00

Surgical

Anatomy

Laboratorj'

Bressler 1

Optional period
Pathology

Immunology

Immunology Laboratory — Section work during last two months.

Locations of Lecture Halls and Laboratories:
Adm. 1 — First floor. Administration BuUding, Lombard and Greene Streets.
C. H. — Chemical HaU, Lower Hall, Lombard and Greene Streets.
Amp.— Wilson Memorial Amphitheatre, New University Hospital, Greene and Redwood Streets, Eighth Floor.

U. H. D.— University Hospital Dispensary, Old Hospital Building.
Laboratories:

Physiology, Pharmacology, Surgical Anatomy— Bressler Building.
Bacteriology, Immunology, Pathology, Second Floor, 31 S. Greene Street.
Mid-Year Examinations— January 17-22, 1949
Pinal Examinations— May 23-2S, 1949

ORGANIZATION OF THE CURRICULUM

THIRD YEAR SCHEDULE
SEPTEMBER 16, 1948 TO JUNE 4, 1949

SCHEDULE 1

Hours

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

8.30

to
9.20

(Whole Class)

Obstetrics

C.E.

tGynecology

Mar. 21 to
May 9

(Whole Class)

Surgery

C.E.

(Whole Class)

Obstetrics

C.E.

tGsmecology

Mar. 23 to
May 11

(Whole Class)
Surgery
C.E.

(Whole Class,

Pathology

C.E.

(\Mio!e Class)

Surgerj'

C.E

t Anaes thesiology

Mar. 12 to May 14

Amp.

9.30

to
10.00

Transfer to Baltimore City Hospitals

10.00

to
12.00

Physical Diagnosis, Pathology, Neurology and Pediatrics at B. C. H.

12.00
to

1.00

Transfer

and

Lunch

Transfer

and

Lunch

Transfer

and

Lunch

(Whole Class)

Clinical

Pathology

Bresskr Z

Lunch

1.00

2.00

(Whole Class)

Nose & Thioat,

Urology,

Otology,

Proctology,

Plastic Surgery

C.E.

(Whole Class)

•Gynecology

tEye— 10 wks.

Jan. 27 to

Apr. 6

tOncology

— 5 wks.

Apr. 13 to

May 11

C.E.

Medical
Clinic

B. C. E.

Obstetrical
Clinic

B. C. B.

2.00

to
4.00

(Whole Class)

Pathology Laboratory

Surgery

Pediatrics
B. C. E.

(Whole Class)

Clinical

Pathology

Laboratory
Brtssler 5

Surgery

Pediatrics
B.C.E.

4.00

to
5.00

(Whole Class)

•Physical

Diagnosis,

fPsychiatry,

fLegal Medicine

C.E.

(Whole Class)
Hygiene and
Pubh'c Health

C.E.

Orthopaedics

Roentgenology

B. C. E.

Orthopaedics
B. C. E.

* First Semester.

t Second Semester.

ORGANIZATION OF THE CURRICULUM

THIRD YEAR SCHEDULE

SEPTEMBER 16, 1948 TO JUNE 4, 1949

SCHEDULE 2

Hours

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

8.30
to

9.20

(Whole Class)

Obstetrics

C.E.

tGynecology

Mar. 21 to

May 9

(Whole Class)
Surgery
C.H.

(Whole Class)

Obstetrics

C.H.

tGynecology

Mar. 23 to

May 11

(Whole Class)
Surgery
C.H.

(Whole Class)

Pathofogy

C.E.

(Whole Class)

Surgery

C.H.

Anaesthesiology

Mar. 12 to May 14

Amp.

9.30

to
10.20

Pediatrics
C.H.

•Medicine
C.E.

•Medicine
C.H.

•Therapeutics
C.H.

•Medicine
C.H.

Neurology
C.H.

10.30

to
12.30

Operative Surgery — Bressler 6
Medical and Surgical Dispensaries — (Univ. and Mercy Sections)

12.30

1.00

Lunch

1.00

2.00

Sam
Schec

e as
lulel

Medical
Clinic
Amp.

Same as
Schedule 1

Psychiatry
Dermatology

U. H. Disp.

2.00

to
4.00

Ophthalmoscopy
(5 weeks)
B. E. B.

Obstetrics

(S weeks)

Univ. Hosp. Dbp.

Otology (5 wks.)

Univ. Hosp.

3-C

4.00

to
5.00

Obstetrics
St. 2

• Pediatrics, January 11 to 14 and May 10 to 13, 1949.

The Junior Class will be divided into two sections — A and B. Each section reports to classes in keeping with the
following schedule assignment, in which the letters represent the class sections and the numerals indicate the schedules ta
be followed for the periods shown.

Schedule Assignment
Periods Sections and Schedules

September 16, 1948 to January 15, 1949 „ A-1, B-2

January 24 to May 14, 1949 „ B-1, A-2

Locations of Lecture Halls, etc.

A. H. — Anatomical Hall, Upper Hall, N. £. Cor. Lombard and Greene Streets.
Amp. — Wilson Memorial Amphitheatre, New University Hospital, Eighth Floor.

B. C. H.— Baltimore City Hosps., 4940 Eastern Ave.

B. E. H.— Baltimore Eye, Ear and Throat HospiUl, 1214 EuUw Place.
Bressler — Bressler Building, 29 S. Greene Street.

C. H. — Chemical Hall, Lower Hall, N. E. Cor. Lombard and Greene Streets.
Univ. Hosp. — New University Hospital, Greene and Redwood Streets.

U. H. Disp. — Old Hospital Building, S. W. Cor. Lombard and Greene Streets.
31 — 31 South Greene Street.

Clinical Pathology Laboratory — Fifth Floor, Bressler Btiilding.
Pathology Laboratory — 31 South Greene Street, Special Rooms, Basement.
Mid-Year Examinations— January 17-22, 1949
Final Examinations— May 16-28, 1949

ORGANIZATION OF THE CURRICULUM

FOURTH YEAR SCHEDULE

SEPTEMBER 16, 1948 TO JXJNE 4, 1949
UNIVERSITY SECTION

Hours

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

9.00

to
11.00

Ward Classes

Medicine
Surgery
Obstetrics
Pediatrics

Ward Classes

Medidne

Surgery

Gynecology

Ward Classes

Medicine
Surgery
Obstetrics
Pediatrics

Ward Classes

Medicine

Surgery

Gynecology

Ward Classes

Medicine
Surgery
Obstetrics
Pediatrics

Ward Classes

Medidne
Surgery
Gynecology
Pediatrics

11.00

to
12.00

Clinical
Clerkships

Ward Work

Clinical
Pathological
Conference

C.H.

Surgical
Clinic

Amp.

Medical
Clinic

Amp.

Pediatric
Clinic

Amp.

12.00
to
2.00

Dispensary
Lunch

(12-1)

Orthopaedic

Cliiic

Amp.

2.15

to
3. IS

Dermatology

Clinic

1st time

Full Class

Amp.
thereafter
University
Dispensary

Neurology
Clinic

Amp.

Eye and Ear
Clinic

(Full Class at
Univ. Hosp.)

Amp.

Obstetrical
Clinic

(Full Class at
Univ. Hosp.)

Amp.

Hygiene and
Public Health

(Full Class at
Univ. Hosp.)

Amp.

(1-2)
Dermatology

Amp.

Ward Classes

See special

schedule

Medical School

bulletin board

Ward Classes

Medicine

Therapeutics

Neurology

Medical Section

3.30

5.00

Proctology

Urology
Amp.

Nose and
Throat

Orthopaedic
Surgery
{Kernan
Hospital)

Surgical Section

Oncology

(3.30-4.30)

Amp.

Eye and Ear

Psychiatry
Amp.

Special Section

University Sections on Medicine and Gynecology report at 8.30.

The Senior Class is divided into two sections, which report, one at Lombard and Greene Streets, the other at Calvert
and Saratoga Streets for one semester each, then rotate.

Each section of the class is divided into three groups — Medical, Surgical, and Spedal. These groups will rotate on
the following dates:

First Semester Second Semester

1st period Sept. 16-Oct. 23 1st period Jan. 24-Feb. 26

2nd period Oct. 25-Nov. 27 2nd period Feb. 28-Apr. 2

3rd period Nov. 29-Jan. 15 3rd period Apr. 4-May 7

C. H. — Chemical Hall — N. E. Cor. Lombard and Greene Streets.
Amp. — Wilson Memorial Amphitheatre — New University Hospital.
Room 34 — Second floor, Calvert and Saratoga Streets.
Univ. Section Dispensary schedule posted in Old Hospital Bldg.

Mid-Year Examinations — January 17-22, 1949
Final Examinations — May 9-14, 1949

ORGANIZATION OF TEE CURRICULUM

SEPTEMBER 16, 1948, TO JUNE 4, 1949
MERCY SECTION

Hours

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

9.00

10.00

Clinical
Clerkships

Surgical
Pathology or
Chest Surgery

Room 34

Clinical
Pathological
Conference

Room 34

Surgical
Clinic

Room 34

Medical
Clinic

Room 34

Pediatric
Clinic

Room 34

Medical
Ward Work

10.00
to

Medical
Dispensary

Group A

Medical
Dispensary

Group B

Medical
Dispensary

Group A

Medical
Dispensary

Group B

Medical
Dispensary

Group A

Medical
Dispensary

Group B

Medical
Section

12.00

Surgical
Ward Work

Surgical
Section

•Pediatrics

Gynecology
•Pediatrics

•Pediatrics

Gynecology
•Pediatrics

•Pediatrics

♦Pediatrics

Special
Section

Lunch
Dispensary

(12-1)

Orthopaedic

Clinic

Room 34

Neurology

G.I.

Neurology

G.I.

Neurology

Medical A

Orthopaedic

Dermatology

Orthopaedic

Dermatology

Orthopaedic

(1-2)
Dermatology

Medical B

12.00

to
2.00

G.U.

Follow up
Surgical Clinic

G.U.

Surgical A

N. &T.

Proctology

N. &T.

Proctology

N. &T.

Surgical B

Pediatrics
(U.H.)

Pediatrics

(U.H.)

Special A

Pediatrics
(U.H.)

Special B

2.15

3.15

Dermatology

Clinic

1st time

Full Class

Amp.
thereafter
University
Dispensary

Neurology
Clinic

Room 34

Eye and Ear
Clinic

(Full Class at
Univ. Hosp.)

Amp.

Obstetrical
Clinic

(Full Class at
Univ. Hosp.)

Amp.

Hygiene and
Public Health

(Full Class at
Univ. Hosp.)

Amp.

See Special
Schedule

Medicine

G.I.

Medicine

Neurology

Medical
Section

3.30

5.00

Orthopaedics

N. &T.

Proctology

Roentgenology

Surgical
Section

Pediatrics

Public Health

Pediatrics
(U.H.)

Psychiatry

(U.H.)

Special
Section

Mercy Pediatrics Group

Here for Dispensary and Thursday 3:30 class— other
times stay at Mercy.

* The Special Section is divided into two groups:
University Pediatrics Group

The last 6 men are assigned to Mercy; the remainder
report to University. Monday, Wednesday, Friday
and Saturday

9:00—10:00 W^ard, University Hospital
10:00— 11:00 Lecture 5C
11:00—12:00 Clinic— Amp.
12:30— 2:00 Dispensary
Thursday

3:30 — 5:00 Dr. Finkelstein — Amp.
The Senior Class is divided into two sections, which report, one at Lombard and Greene Streets, the other at Calvert
and Saratoga Streets for one semester each, then rotate.

Each section of the class is divided into three groups — Medical, Surgical, and Special. These groups will rotate on
the following dates:

First Semester

1st period Sept. 16-Oct. 23

2nd period Oct. 25-Nov. 27

3rd period Nov. 29- Jan. IS

Second Semester

1st period Jan. 24-Feb. 2i

2nd period Feb. 28-Apr. 2

3rd period Apr. 4-May 7

C.H. — Chemical Hall — N. E. Cor. Lombard and Greene Streets.

Amp.— Wilson Memorial Amphitheatre— New University Hospital

Room 34 — Second floor, Calvert and Saratoga Streets.

Mid-Year Examinations— JsLumry 17-22, 1949

Final Examinations — May 9-14, 1949

GRADUATES

UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
AND COLLEGE OF PHYSICIANS MTD SURGEONS

GRADUATES, JUNE 5, 1948

Alecce, Angelo Andrew, JB. 5. .Maryland

Allison, George Malcolm Illinois

Aponte, Joseph Loots Puerto Rico

Auld, David Marjdand

Baker, Frank William, Jr Maryland

Beyer, David Henry Minnesota

BisANAR, James Milton . . North Carolina
Bond, Donald Buckey, ^.B.. . .Maryland
Bronstein, Eugene Leonard. New York
BucHNESs, John Michael, A.B.. Maryland

Bullock, John Boyd Virginia

BuLLUCK, Matt Heyer .... North Carolina

Chamovitz, Robert Pennsylvania

Chelton, Alice Katherine Graybill

West Virginia
Condron, James Frank. . . .Pennsylvania
Crecraet, Harold James, A.B.

Pennsylvania
Dalton, James Bkeckenridge, Jr.

Virginia
Dempsey, Raymond Joseph, £.5'. .Illinois
DwYER, Frank Philip, Jr. . . Pennsylvania

Ensor, Robert Ellwood Maryland

GoLOMBEK, Leonard Harry. . . .Maryland

Grant, Bowie Linn Maryland

Green, James William ........ Maryland

Hamrick, George Vincent Maryland

Hankins, John Roland Virginia

Heldrich,. Frederick Joseph, Jr., A.B.

Maryland
Hoback, Florence Kunst, A.B.

West Virginia
Hobart, Richard Loren, Jr.

District of Columbia
Holloway, William Jackson. . .Maryland
Insley, Marion Clarence, Jr. . Maryland

Kastner, Lee Norman Maryland

Kaufman, Raymond Henry. . .New York
Kemp, Katherine Virdin, yl.5. . Maryland
Kennedy, Carl Hubert, Jr. Pennsylvania
Leograndis, Stephen Cosmos

Massachusetts

Lithgow, Charles Henry Maryland

Mack, Harry Patterson. .. .New York

Mallis, Nicholas Maryland

Matthews, Burton Vincent, A.B.

Marvland

Matthews, Roland Dellwood

North Carolina
McCauley, Betty Jane, B.S. . . . Maryland
McCrumb, Fred Rodgers, Jr. . . Maryland
MoHLER, Donald Ignatius, Jr. . Maryland
Newell, Edward Alphonso .... Maryland
Niswander, Guy Donald. .West Virginia
Nolan, Paul Vernon, B.S.

North Carolina
Padussis, Stephen Konstant. . .Maryland
Petersen, Phyllis Ann, A.B... . Maryland

Platt, Julian Jay Maryland

Powell, Albert Milton, Jr. . . . Maryland
Redding, Joseph Stafford, A.B.

North Carohna

Rhyne, Jimmik Lee North Carolina

Rodriguez, Edsel Antonio . . Puerto Rico

Rudolph, Robert Lee Ohio

ScHERR, Merle Sundrell. .West Virginia
Schwartz, Benson Charles. . . . Maryland

Shell, John Robert Virginia

Silverman, Benjamin K., ^.5.. Maryland
Silverstein, Daniel Lewis .... Maryland
SiwiNSKi, Thaddeus Charles, A.B.

Maryland
Smelser, Rennert Marquette . Maryland

Snyder, William Allen Maryland

Stahl, Robert Ray Pennsylvania

Swisher, Kyle Young, Jr. West Virginia

Tarr, Norman Maryland

Tate, Allen Denny, Jr., B.S.

North Carolina
Theuerkauf, Frank Joseph, Jr.

Pennsylvania
Thomas, Clyde Dana, Jr.. West Virginia

Thuss, William Getz, Jr Alabama

Walters, Hezekiah G., Jr., A.B.

North Carohna
Ware, Charles Ingersoll. .New Jersey
Waterman, Roger Sherman

Pennsylvania
Welborn, James Todd, B.S.

North Carolina

Whitehorn, Clark Allan Michigan

Wilson, John Dean Penns^dvania

Womack, William Spengler Virginia

Young, John Paul Maryland

HONORS

University Prize Gold Medal

John Roland Hankins

Certificates of Honor

Charles Harry Lithgow
Fr.vnk Joseph Theuerkauf, Jr.

William Getz Thuss, Jr.
Fred Rodgers McCrumb, Jr.

Kyle Young Swisher, Jk.

90 THE SCHOOL OP MEDICINE, UNIVERSITY OP MARYLAND

INTERNSHIPS— GRADUATES OF JUNE 5, 1948
July 1, 1948-June 30, 1949

Alecce, Angelo Andrew St. Joseph's Hospital, Baltimore, Md.

Allison, George Malcolm Illinois Masonic Hospital, Chicago, 111.

Aponte, Joseph Louis Mercy Hospital, Baltimore, Md.

AuLD, David University Hospital, Baltimore, Md.

Baker, Frank William, Jr St. Joseph's Hospital, Baltimore, Md.

Beyer, David Henry U. S. Naval Hospital, Bremerton, Wash.

BiSANAR, James Milton University Hospital, Baltimore, Md.

Bond, Donald Buckey Baltimore City Hospitals, Baltimore, Md.

Bronstein, Eugene Leonard Queens General Hospital, Jamaica, N. Y.

Buchness, John Michael Mercy Hospital, Baltimore, Md.

Bullock, John Boyd Medical College of Virginia, Richmond, Va.

BuLLUCE, Matt Heyer New York Polyclinic Hospital, New York, N. Y.

Chamovitz, Robert Montefiore Hospital, Pittsburgh, Pa.

Chelton, Alice Graybill Marine Hospital, Detroit, Mich.

CoNT)RON, James Frank St. Mary's Hospital, Philadelphia, Pa.

Crecraft, Harold James U. S-. Naval Hospital, Great Lakes, 111.

Dalton, James Breckenridge, Jr.

Medical College of Virginia Hospital, Richmond, Virginia

Dempsey, Raymond Joseph St. Luke's Hospital, Chicago, 111.

DwYER, Frank Philip, Jr St. Agnes Hospital, Baltimore, Md.

Ensor, Robert Ellwood Mercy Hospital, Baltimore, Md.

GoLOMBEK, Leonard Harry West Baltimore General Hospital, Baltimore, Md.

Grant, Bowie Linn West Baltimore General Hospital, Baltimore, Md.

Green, James William Harrisburg Hospital, Harrisburg, Pa.

Hamrick, George Vincent Mercy Hospital, Pittsburgh, Pa.

Hankins, John Roland University Hospital, Baltimore, Md.

Heldrich, Frederick Joseph, Jr University Hospital, Baltimore, Md.

HoBACK, Florence Kunst St. Mary's Hospital, Huntington, W. Va.

HoBART, Richard Loren, Jr.. .Central Dispensary & Emergency Hospital, Wash., D. C.

Holloway, William Jackson University Hospital, Baltimore, Md.

Insley, Marion Clarence, Jr. . . South Baltimore General Hsopital, Baltimore, Md.

Kastner, Lee Norman Sinai Hospital, Baltimore, Md.

Kaufman, Raymond Henry, Jr Beth Israel Hospital, New York City, N. Y.

Kemp, Katherine Virdin West Baltimore General Hospital, Baltimore, Md.

Kennedy, Carl Hubert, Jr Episcopal Hospital, Philadelphia, Pa.

Leograndis, Stephen Cosmos Cooper Hospital, Camden, New Jersey

Lithgow, Charles Harry United States Marine Hospital, Baltimore, Md.

Mack, Harry Patterson University Hospital, Baltimore, Md.

Mallis, Nicholas University Hospital, Baltimore, Md.

Matthews, Burton Vincent Pennsylvania Hospital, Philadelphia, Pa.

Matthews, Roland Dell wood Watts Hospital, Durham, N. C.

McCauley, Elisabeth Kings County Hospital, Brooklyn, N. Y.

McCrumb, Fred Rodgers, Jr University Hospital, Baltimore, Md.

Mohler, Donald Ignatius, Jr Bon Secours Hospital, Baltimore, Md.

Newell, Edward Alphonso .... South Baltimore General Hospital, Baltimore, Md.
NiswANDER, Guy Donald Cincinnati General Hospital, Cincinnati, Ohio

INTERNSHIPS 1948-1949 91

Nolan, Paul Vernon Tampa Municipal Hospital, Davis Island, Tampa, Fla.

Padxjssis, Stephen Konstant St. Agnes Hospital, Baltimore, Md.

Petersen, Phyllis Ann University Hospital, Baltimore, Md.

Platt, Julian Jay United States Marine Hospital, Galveston, Texas

Powell, Albert Milton, Jr Mercy Hospital, Baltimore, Md.

Redding, Joseph Stafford Rey Hospital, Raleigh, N. C.

Rhyne, Jimmie Lee Roper Hospital, Charleston, S. C.

Rodriguez, Edsel Antonio St. Agnes Hospital, Baltimore, Md.

Rudolph, Robert Lee University Hospital, Columbus, Ohio

ScHERR, Merle Sundrell Sinai Hospital, Baltimore, Md.

ScHvi^ARTZ, Benson Charles Sinai Hospital, Baltimore, Md.

Shell, John Robert Mercy Hospital, Baltimore, Md.

Silverman, Benjamin K Sinai Hospital, Baltimore, Md.

SiLVERSTEiN, Daniel Lewis West Baltimore General Hospital, Baltimore, Md.

Siwinski, Thaddeus Charles Mercy Hospital, Baltimore, Md.

Smelser, Rennert Marquiette Mercy Hospital, Baltimore, Md.

Snyder, William Allen United States Naval Hospital, Portsmouth, Va.

Stahl, Robert Ray Mercy Hospital, Pittsburgh, Pa.

Swisher, Kyle Young, Jr University Hospital, Baltimore, Md.

Tarr, Norman Marine Hospital, U. S. Public Health Service, Baltimore, Md.

Tate, Allen Denny, Jr Episcopal Hospital, Phila., Pa.

Theuerkauf, Frank Joseph, Jr Mercy Hospital, Baltimore, Md.

Thomas, Clyde Dana, Jr Mercy Hospital, Baltimore, Md.

Thuss, William Getz, Jr. . . Grace-New Haven Community Hospital, New Haven, Conn.

Walters, Hezekiah G., Jr Union Memorial Hospital, Baltimore, Md.

Ware, Charles Ingersoll Atlantic City Hospital, Atlantic City, N. J.

Waterman, Roger Sherman United States Marine Hospital, Cleveland, Ohio

Welborn, James Todd Charlotte Memorial Hospital, Charlotte, N. C.

Whitehorn, Clark Allen Detroit Receiving Hospital, Detroit, Mich.

Wilson, John Dean United States Naval Hospital, Chelsea, Mass.

WoMACK, William Spengler Bon Secours Hospital, Baltimore, Md.

Young, John Paul West Baltimore General Hospital, Baltimore, Md.

MATRICULATES

SENIOR CLASS, SEPTEMBER 18, 1947 TO JUNE 5, 1948

Alecce, Angelo Andrew, B.S., Loyola College, 1945 Maryland

Allison, George Malcolm, Marquette University Illinois

Aponte, Joseph Louis, University of Puerto Rico Puerto Rico

AuLD, David, Swarthmore College Marsdand

Baker, Frank William, Jr., University of Chicago Maryland

Beyer, David Henry, Cornell University Minnesota

BiSANAR, James Milton, Davidson College North Carolina

Bond, Donald Buckey, A.B., Western Maryland College, 1938 Maryland

Bronstein, Eugene Leonard, Emory University New York

BucHNESS, John Michael, A.B., Loyola College, 1944 Maryland

Bullock, John Boyd, University of Richmond Virginia

BuLLUCK, Matt Heyer, Guilford College North Carolina

Chamovitz, Robert, Bethany College Pennsj'lvania

Chelton, Alice Katherine Graybill, University of Chicago West Virginia

Condron, James Frank, Mtihlenberg College Pennsylvania

Crecraft, Harold James, A.B., Taylor University, 1944 Pennsylvania

Dalton, James Beeckenridge, Jr., University of Richmond Virginia

92 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Dempsey, Raymond Joseph, B.S., University of Noire Dame, 1944 Illinois

DwYER, Frank Phtlip, Jr., Mt. St. Mary^s College Pennsylvania

Ensor, Robert Ellwood, Western Maryland College Maryland

GoLOMBEK, Leonard Harry, University of Maryland Maryland

Grant, Bowie Linn, Potomac State School of West Virginia Maryland

Green, James Wdlliam, Western Maryland College Maryland

Hamrick, George Vincent, Washington University Maryland

Hankins, John Roland, University of Virginia Virginia

Heldrich, Frederick Joseph, Jr., A.B., Gettysburg College, 1945 Maryland

HOBACK, Florence Kunst, A.B., West Virginia University, 1944. ....... .West Virginia

Hobart, Richard Loren, Jr., Washington and Lee University District of Columbia

Hollow AY, William Jackson, Western Maryland College Maryland

Insley, Marion Clarence, Jr., University of Maryland Maryland

Kastner, Lee Norman, University of Pennsylvania Maryland

Kaufman, Raymond Henry, University of North Carolina New York

Kemp, Katherxne Virdin, A.B., College of Notre Dame of Maryland, 1943. . . .Maryland

Kennedy, Carl Hubert, Jr., University of Virginia Pennsylvania

Leograndis, Stephen C, Duke University Massachusetts

LiTHGOw, Charles Henry, Loyola College Maryland

Mack, Harry Patterson, Washington University New York

Mallis, Nicholas, Cornell University Maryland

Matthews, Burton Vincent, A.B., The Johns Hopkins University, 1943; Cornell

University Maryland

Matthews, Roland Dellwood, University of North Carolina; University of North

Carolina School of Medicine, September 1944— March 1946 North Carolina

McCauley, Elisabeth, B.S., University of Maryland, 1943 Maryland

McCrumb, P^ed Rodgers, Jr., Loyola College Maryland

MoHLER, Donald Ignatius, Jr., Loyola College Maryland

Newell, Edward Alphonso, Western Maryland College Maryland

Niswander, Guy Donald, University of Michigan West Virginias

Nolan, Paul Vernon, B.S. in Medicine, University of North Carolina, 1945;

University of North Carolina School of Medicine, September 1944-March 1946

North Carolina

Padussis, Stephen Konstant, University of Maryland Maryland

Petersen, Phyllis Ann, A.B., University of Michigan, 1943 Maryland

Platt, Julian Jay, Loyola College Maryland

Powell, Albert Milton, Jr., University of North Carolina Maryland

Redding, Joseph Stafford, A .B., University of North Carolina, 1943; University

of North Carolina School of Medicine, September 1944-March 1946. .North Carolina

Rhyne, Jimmie Lee, University of North Carolina North Carolina

Rodriguez, Edsel Antonio, College of the Holy Cross Puerto Rico

Rudolph, Robert Lee, Ohio University Ohio

^Sanford, William Gordon, University of North Carolina, University of North

Carolina School of Medicine, September 1944— March 1946 North Carolina

ScHERR, Merle Sundrell, West Virginia University West Virginia

Schwartz, Benson Charles, University of Maryland Maryland

Shell, John Robert, University of Richmond Virginia

Silverman, Benjamin K.,^.5., The Johns Hopkins University, 1947 Maryland

Silversteest, Daniel Lewis, Loyola College Maryland

SiwiNSKi, Thaddeus Charles, A.B., Loyola College, 1944 Maryland

Smelser, Rennert Marquette, University of Maryland Maryland

Snyder, William Allen, The Johns Hopkins University Maryland

Stahl, Robert Ray, University of New Hampshire Pennsylvania

Swisher, Kyle Young, Jr., Bethany College West Virginia

Tarr, Norman, Washington College Maryland

Tate, Allen Denny, Jr., B.S. in Medicine, University of North Carolina, 1945;

University of North Carolina School of Medicine, September 1944-March

1946 North Carolina

Theuxrkauf, Frank Joseph, Jr., Villa Maria College Pennsylvania

Thomas, Clyde Dana, Jr., Bethany College West Virginia

^ Certified on June 7, 1948 for graduation. Diploma will be awarded September 15,
1948.

MATRICULATES 93

Thxtss, William Getz, Jr., Emory University Alabama

Walters, Hezekiah G., Jr., A.B., University of North Carolina, 1944. . . .North Carolina

Ware, Charles Ingersoll, Wake Forest College New Jersey

Waterman, Roger Sherman, Bethany College Pennsylvania

Welborn, James Todd, B.S., Davidson College, 1944; University of North Carolina

Scliool of Medicine, September 1944— March 1946 North Carolina

Whitehorn, Clark Allan, The Johns Hopkins University Michigan

Wilson, John Dean, Bethany College Pennsylvania

Womack, William Spengler, Emory and Henry College Virginia

Young, John Paul, The Johns Hopkins University Maryland

JUNIOR CLASS, SEPTEMBER 18, 1947 TO JUNE 5, 1948

Abraham, Robert Auman, B.S., Franklin and Marshall College, 1945 Pennsylvania

Bachman, Leonard, B.S., Franklin and Marshall College, 1946 Maryland

Barnard, John William, B.S., Milligan College, 1937 Maryland

Belkin, Joseph William, College of the Holy Cross Connecticut

Benjamin, William Philip, A.B., Brooklyn College, 1943 New York

Bennett, Sara Elizabeth, A.B., Randolph-Macon, 1930; University of North

Carolina School of Medicine, September 1945-June 1947 North Carolina

Blundell, Albert Edward, Temple University Utah

Bradford, Edward, West Virginia College; University of North Carolina; University

of North Carolina School of Medicine, September 1945-June 1947 Georgia

Cline, James Alexander, III, University of Pennsylvania Nebraska

Deringee, Florence Huhtt, B.S., Washington College, 1945 Maryland

Ensor, Wilmer Clifton, Jr., B.S., Loyola College, 1945 Maryland

Eubanks, Otha Albert, Jr., Duke University North CaroKna

Forman, Robert Blaine, University of Oregon Oregon

Fravel, Charles Richard, Cornell University Virginia

Gill, Joseph Edward, Union College Pennsylvania

Gorten, Martin Klaus, A.B., Western Maryland College, 1943 New Jersey

Gray, Harry Williams, Duke University Maryland

GuiDO, Angelina, A.B., West Virginia University, 1945; West Virginia University,

School of Medicine, September 1945-June 1947 West Virginia

Harris, James Radcliffe, Temple University Pennsylvania

Henderson, Charles Thomas, The Johns Hopkins University Illinois

Humphreys, Charles Wesley, Jr., Duke University District of Columbia

Knabe, George William, Jr., The Johns Hopkins University Michigan

Lewis, Thomas Earl, Pennsylvania State College Pennsylvania

Lock, Burton Vernon, The Johns Hopkins University Maryland

London, Nathaniel Jacob, The Johns Hopkins University Maryland

Longley, George Henry, University of Minnesota Maryland

Lukens, James Thomas, Vanderbilt University Pennsylvania

Malcarney, Alberta Rose, A.B., University of Southern California, 1944. . . .California

Mattax, Harry McCoy, Western Maryland College Maryland

Matthews, Mary Elizabeth, B.S., North Carolina State 1936; M.S., University
of North Carolina, 1945; University of North Carolina, School of Medicine,

Sept. 1945-June 1947 North CaroHna

May, Homer Woodrow, B.S., University of Pittshirgh, 1944 Pennsylvania

McCord, Charles Frederic, Pennsylvania State College Indiana

Middleton, Edmund Bishop, The Johns Hopkins University Rhode Island

Miller, Max Jay, University of Richmond Maryland

Mover, John Lewis, III, University of Minnesota Pennsylvania

Neumayer, Francis, University of Maryland Pennsylvania

Newell, Josephine Evelyn, University of the State of South Carolina. . . .North Carolina

NiCKLAS, Gilbert Lee, B.S., Franklin and Marshall College, 1946 Maryland

Panzarella, John Henry, Fordham University New York

Parelhoff, Merrill Elliott, University of Maryland Maryland

PiTTMAN, Robert Raikes, A.B., Wake Forest College, 1937; University of North

Carolina, School of Medicine, September 19'5-June 1947 North Carohna

Pleet, Jerome, Stanford University, University of Texas School of Medicine, Sep-
tember 1945-May 1946 '. Maryland

Raskin, Howard Frank, The Johns Hopkins University Maryland

94 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Riddel, Cliitord Thurston, Jr., A.B., Bridgewater College, 1933 Virginia

RoEHRiG, Charles Burns, Vanderhilt University Massachusetts

Rosen, Robert Reuben, A.B., University of North Carolina, 1945; University of

North Carolina, School of Medicine, September 1945-June 1947 .... North Carolina

Sarewitz, Albert Bernard, University of Pennsylvania New Jersey

ScHER, Jordan Mayer, A.B., Wesleyan University, 1946 Maryland

ScHMALE, Arthxtr Henry, Jr., Pennsylvania State College Nebraska

ScHNAPER, Nathan, B.S., Washington College Maryland

ScHREiBER, Richard DAvm, Bethany College Illinois

Sherrard, Margaret Lee, A.B., Seton Hill College, 1945 West Virginia

Smith, Meredith Parks, St. Lawrence University Minnesota

Snider, Kenneth Bruce, University of Maryland Texas

Spittel, John Allen, Jr., B.S., Franklin and Marshall College, 1944 Maryland

Stabler, Earlin John, University of Maryland Pennsylvania

Stanfield, Elwin Eugene, University of Pennsylvania California

Steckler, Robert Joseph, A.B., Evansville College, 1943 Indiana

Stevenson, Edward Ward, Duke University Virginia

Strahan, John Franklin, Duke University Maryland

TiLLEY, Russell McFarlane, Jr., University of Rochester New York

TiMANUS, James Kyner, Oberlin College Ohio

Tramer, Arnold, University of Maryland Maryland

Trettin, Gene Douglas, Ur sinus College Maryland

Warnock, Robert George, Bates College Ohio

Watson, Frank Yandle, Duke University North Carolina

Welch, Elbert Sylvester, Duke University Alabama

WoLEE, Carolyn DeWitt, A.B., Hollins College, 1945 New Jersey

ZiEGLEE, John Bosley, A.B., Gettysburg College, 1942 Maryland

SOPHOMORE CLASS, SEPTEMBER 18, 1947 TO JUNE 5, 1948

Andersen, William Andrew, The Johns Hopkins University Maryland

Bacon, John Louis, Wagner College New York

Bagley, Charles, B.S., Loyola College, 1945 Marj'^land

Baumann, Wilbur Nelson, University of Maryland Maryland

BiSGYER, Jay Lewis, University of Pennsylvania District of Columbia

Bleecker, Harry Harlan, Jr., University of California California

Borges, Francis Joseph, University of Maryland Maryland

Bradshaw, Raymond, Jr., B.S., University of Maryland, 1943 Maryland

Bronushas, Joseph Benedict B., B.S., Loyola College, 1946 Maryland

BxmKEY, Fred Jamison, St. Francis College Maryland

Chelton, Louis Gxt^, Gettysburg College Maryland

CoLLER, Jerome Joel, A.B., The Johns Hopkins University, 1946 Maryland

CoRPENNiNG, Tom Nye, University of North Carolina North Carolina

Co wen, Joseph Robert, The Johns Hopkins University Maryland

Cracraet, William Atkinson, B.S., Virginia Military Institute, 1939. . . .West Virginia

Daly, Harold Lawrence, Jr., University of Maryland Maryland

Deitz, Leonard Loeb, A.B., University of North Carolina, 1946 Mar\-land

Demarest, Elinor Weed, A.B., Randolph-Macon Woman's College, 1946 Maryland

Demarest, Lawrence Mann, B.S., Bowdoin College, 1945 New York

Demmy, Nicholas, B.S., University of Pittsburgh, 1942 Pennsylvania

Edmunds, Frederick Thomas, B.S., Hampden-Sydney College, 1941 West Virginia

GooGiNS, Charles George, B.S., University of Maryland Kansas

Gould, Vlrginia. Marie, B.S., Nazareth College, 1941 New York

Greenstein, George Herbert, A.B., The Johns Hopkins University, 1941. . .Maryland

Hamberry, Leonard Gerard, A.B., Loyola College, 1940 Mar>^land

Hawkins, George Kenneth, B.S., Upsala College, 1943 New Jersey

Healy, John Clauson, University of ConnecPicid Connecticut

Henson, Stanley Willard, Jr., B.S., Oklahoma A. & M. College, 1945 Maryland

Heuman, Philip Walter, B.S., University of Michigan, 1941 Maryland

Hoesteter, Grace, College of Wooster Ohio

Hoyt, Irvin Gorman, A.B., St. Johns College, Annapolis, 1939 Mar}4and

HuEEER, Sarah Virginia, B.S., University of Maryland, 1940 Mar>iand

HusTED, Harriet Lamont, A.B., Wells College, 1944 New Jersey

MATRICULATES 95

Hyle, John Charles, B.S., Loyola College, 1942 Maryland

Ibsen, Maxwell, A.B., The Johns Hopkins University, 1939; A.M., University

of Pennsylvania, 1940 Pennsylvania

Iten, George Joseph, A.B., Goshen College, 1946 California

Jenkins, Sarah Anetta, B.S., George Washington University, 1946 Maryland

Jensen, Roy Davto, B.S., University of Nevada, 1941 Nevada

Kasik, Frank Thomas, University of Maryland Maryland

Kelley, Gordon William, University of Maryland Maryland

Lewis, Thomas Franklin, Jr., A.B., Western Maryland College, 1941 Maryland

Lichtenberg, Joseph David, A.B., The Johns Hopkins University, 1943 Maryland

Martin, George William, Jr., University of Delaware Delaware

McElvain, Wllbert Harding, B.S., Grove City College, 1943 Pennsylvania

Miller, Dorothea Anna, B.S., Washington College, 1946 Maryland

Miller, Robert Eugene, A.B., Bridgewater College, 1943 Maryland

Myers, Evangeline, A.B., West Virginia University, 1945; A.M., Columbia Uni-
versity, 1946 West Virginia

Noguera, Julio Tomas, University of Puerto Rico Puerto Rico

O'Malley, Joseph Edward, Colby College Maryland

Rever, William Benjamin, Jr., Cornell University Maryland

Reynaud, Louis Favrot, Jr., Emory University Illinois

Richardson, Paul Frederick, Baylor University Maryland

Righetti, Milton Raymond, University of California California

Roth, Oliver Ralph, University of Maryland Maryland

Rubin, Seymour Howard, A.B., The Johns Hopkins University, 1946 Maryland

Rudy, Norman Edward, Fresno State College California

Sandler, Robert, B.S., University of Maryland, 1943 Maryland

Shamer, Miriam Abbott, A.B., Gaucher College, 1946 Maryland

Shepherd, Frederick Parker, A.B., Syracuse University, 1935 Maryland

Simmons, Frederic Rudolph, Jr., B.S., Loyola College, 1946 Maryland

Sires, William Oscar, Western Maryland College Maryland

Sklar, Allen Leon, Western Maryland College Maryland

^Smith, Boylston Dandridge, Jr., West Virginia University West Virginia

Smith, Morton, University of Maryland Maryland

SosNOWSKi, Andrew Raymond, B.S., Loyola College, 1945 Maryland

Spaulding, Raymond Charles, Jr., B.S., John B. Stetson University, 1943 Florida

Startzman, Henry Hollingsworth, Jr., Loyola College Maryland

Storm, Mary Elizabeth, A.B., Swarthmore College, 1946 Maryland

SuLKA, Casimir Michael, Loyola College Illinois

Thibadeau, Robert Torndorff, B.S., University of Maryland, 1945 Maryland

Thompson, William Wesley, B.S., Washington College, 1938 Maryland

Upton, Albert Louis, A.B., University of California, 1942 CaKfomia

Van Goor, Kornelius, Calvin College New Jersey

Vicens, Enrique A., University of Ptierto Rico Puerto Rico

White, Fowler Felix, B.S., Trinity College, 1942 Connecticut

Wilson, Clifford Edward, Jr., Bowdoin College Connecticut

Wolf, Ernest Simon, University of Maryland Maryland

Yeager, William Howard, Jr., B.S., University of Maryland, 1944 Maryland

FRESHMAN CLASS, SEPTEMBER 18, 1947 TO JUNE 5, 1948

Arthur, Robert Key, Jr., Mercer University. . . .' Georgia

Barthel, John Paul, Western Maryland College Maryland

Beardsley, Earl Miller, University of Maryland Maryland

Bell, Arthur Keith, A.B., Oberlin College, 1947 Maryland

BiLDER, Joseph, Jr., B.S., University of Akron, 1944 Ohio

^BiLLS, Wilson Leo, University of Maryland Maryland

BiRELY, Beverly Robert, University of Maryland Maryland

Blades, Nancy, A.B., Connecticut College, 1947 New Jersey

BossARD, John Wesley, A.B., Duke University, 1947 Maryland

^Bowen, Paul Allen, Mercer University Georgia

Brannon, John Vandale, Fairmont College West Virginia

Did not complete year.

96 TEE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

BuELL, John Russell, Jr., University of Maryland Maryland

Christopher, Russell Lee, A.B., Bowdoin College, 1947 Massachusetts

Clemmens, Raymond Leopold, B.S., Loyola College, 1947 Maryland

COEEMAN, Kaohlin Miner, A.B., Western Maryland College, 1947 Pennsylvania

Cohen, Solomon, A.B., University of Denver, 1947 Maryland

CuRANZY, Raymond Ralph, Juniata College Pennsylvania

Deckelbaum, Joseph, University of Maryland Maryland

Dettbarn, Ernest Albert, B.S., Randolph-Macon, 1947 Maryland

DoNNER, Leon, B.S., State Teachers College, 1942 ■ Maryland

Dudley, Winston Clark, A.B., Oberlin College, 1943 Massachusetts

Dunn, George Mitchell, Jr., George Washington University District of Columbia

Edwards, David Everett, University of Marylattd District of Columbia

Edwards, William Hunter, Jr., A.B., Johns Hopkins University, 1940 Maryland

Esmond, William George, B.S., University of Maryland, 1940 Maryland

Evans, Otis Druell, Jr., B.S., Davidson College, 1947 North Carohna

Ferguson, Charles Kirkpatrick, Muskingum College Kansas

Fitzgerald, Joseph Carroll, Middlebury College Maryland

^Freeman, Horatio Putnam, B.S., Dickinson College, 1947 Maryland

FuLLiLOVE, Jack, University of Georgia Georgia

Gallaher, James Patrick, Ohio Wesleyan University West Virginia

Garcia- Palmieri, Mario Ruben, University of Puerto Rico Puerto Rico

Gates, John Butler, University of Wisconsin Wisconsin

^Glenn, George Waverly, University of Maryland Maryland

Gordon, Benjamin Dichter, Connecticut College New York

Hatem, Frederick Joseph, Georgetown University Maryland

Hopkins, Robert Charles, B.S., Allegheny College, 1946 Pennsylvania

^Hutchison, William Forrest, Emory University Florida

Johnson, Frederick Miller, B.S., University of Maryland, 1943 District of Columbia

Johnson, Wallace Edward, Wesleyan University New Hampshire

2Karn, William Nicholas, Jr., Alfred University Maryland

Kaschel, Paul Edward, A.B., Wheaton College, 1947 New Jersey

Kindt, Willard Freed, Muhlenberg College Pennsylvania

King, Victor Francis, University of Maryland Maryland

KiPNis, David Morris, A.B., Johns Hopkins University, 1945 Maryland

Knipp, Harry Lester, Loyola College Maryland

Kramer, Hovv^ard Calvin, University of Maryland Maryland

Lamb, William Eugene, B.S., University of Florida, 1947 Florida

Lanning, Theodore Reuney, B.S., Springfield College New Jersey

Leibman, Jack, A.B., Johns Hopkins University, 1947 Maryland

Ley, Leo Henry, Jr., St. Mary's College of Maryland Maryland

Lister, Leonard Melvin, Loyola College Maryland

Love, Robert George, B.S., Massachusetts State College, 1947 Massachusetts

MacDonald, James Melvin, B.S., Loyola College, 1947 Maryland

McFadden, Earl Boyd, B.S., University of Maryland, 1947 Maryland

McFadden, John William, Mt. Union College Ohio

McGrady, Charles Winifred, Jr., A.B., Emory University, 1947 Georgia

Mendez-Bryan, Ricardo Tomas, University of Puerto Rico Puerto Rico

MossER, Robert Schaaf, University of Maryland Maryland

Mutter, Arthur Zelig, Franklin '& Marshall Maryland

Myers, Donald Johnson, B.S., Bethany College, 1934 Ohio

Nygren, Edward Joseph, A.B., Western Maryland College, 1947 Maryland

Orth, John Stambaugh, University of Maryland Maryland

Packard, Douglas Richard, University of Maryland Maryland

Pencheff, Dorris Marie, A.B., University of California, 1946 California

Perilla, Frank Robert, B.S., University of Maryland Maryland

Perry, Henry David, Jr., A.B., Emory University, 1947 Florida

Reeser, Glty McClelland, Jr., A.B., Western Maryland College, 1947 Maryland

Reeves, Henry Gray, Jr., B.S., Wake Forest College, 1947 North Carolina

Reilly, Kathleen Margaret, B.S., Long Island University, 1947 New York

Rex, Eugene Braiden, Vanderbilt College Colorado

^ Did not complete year.

2 Withdrew November 1, 1947,

MATRICULATES 97

Reynolds, Georgia, A.B., Western Maryland College, 1947 Maryland

Rice, Robert Milton, B.S., Dickinson College, 1947 Maryland

ROMBRO, Marvin Jay, A.B., Bucknell University, 1947 Maryland

Rowland, Harry Shepard, Jr., A.B., Weslcyan University, 1947 New Jersey

Saavedra- Amador, Armando, University of Puerto Rico Puerto Rico

Scott, Roger David, University of Virginia Florida

Scully, John Thorsen, Indiana University Indiana

Shea, William Harold Holland, B.S., Loyola College Maryland

Sherry, Samuel Norman, University of Maryland Maryland

SiPPLE, Edward N., Earlham College Maryland

Skipton, Roy Keisosdedy, University of Maryland Maryland

Solomon, David Milton, University of Maryland Maryland

Stone, John Hoskins, University of Maryland Maryland

Tobias, Richard Boyd, B.S., Bucknell University, 1947 Pennsylvania

TwiGG, Homer Lee, Jr., University of Maryland Maryland

Udel, Melvin, A.B., University of Maryland Maryland

Valentine, Clarence Eldred, A.B., Washington College, 1943 Maryland

Venrose, Robert James, A.B., University of Michigan, 1946 Ohio

Watson, Charles Polk, Jr., A.B., West Virginia University, 1947 West Virginia

Weekley, Robert Dean, B.S., Heidelberg College, 1947 Ohio

Wheelwright, Harvey Pfarse, Brigham Young University Utah

Williams, Charles Ray, A.B., Gettysburg College, 1947 Maryland

'Wolfe, Harvey Edward, Lebanon Valley College Pennsylvania

York, Shelley Clyde, Jr., B.S., Guilford College North Carolina

Young, Calvin Lessey, A.B., Haverford College, 1947 Maryland

SPECIAL STUDENTS
John Shelby Metcalf California

STUDENTS IN ART AS APPLIED TO MEDICINE

Margaret Wetherill Wood, R.N Maryland

INTRA MURAL POSTGRADUATE STUDENTS

July 1, 1947 to June 30, 1948

General Anatomy "A" Medical School

Alberto Adam, M.D University of Maryland

Robert Z. Berry, M.D University of Maryland

Rowell Connor Cloninger, M.D University of Maryland

Isaac Gutman, M.D University of Maryland

Robert B. McFadden, M.D University of Maryland

Joseph H. Saunders, M.D Tiilane University

Frank Vanni, M.D N.Y. Medical College

Surgical Anatomy "B"

Vincent A. Cacace, M.D Loyola University, Chicago

Rowell Connor Cloninger, M.D University of Maryland

Gordon Crabb, M.D P. & S. Columbia University

Robert Louis Gibbs, M.D University of Maryland

William H. Heath, Jr., M.D University of Tennessee

Joseph R. Liberto, M.D University of Tennessee

Rush E. Netterville, M.D Louisiana State University

Norman Oliver, M.D Long Island College of Medicine

MICH.A.EL R. Ramundo, M.D University of Maryland

Gynecology & Obstetrics

Hugh B. Brown, Jr., M.D Medical College of Virginia

Donald L. Ferris, M.D University of Rochester

Harold F. Funsch, M.D St. Louis University

^ Did not complete year.

98 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

Gynecology, Oncology and Female Urology

Medical School

Leonard J. Rabhan, M.D University of Georgia

Pathology (Special)

Wm. J. Bryson, M.D University of Maryland

Morris Bitrleson, M.D Duke University

John P. Greene, M.D Johns Hopkins University

Wm. B. Hagan, M.D University of Maryland

H. N. Kagan, M.D George Washington School of Medicine

Wm. R. Raby, M.D University of Maryland

James S. Thomison, M.D New York University

Hugh Vazzana, M.D University of Maryland

James Walker, M.D University of Maryland

Isaac Wright, M.D University of Maryland

EXTRA MURAL POSTGRADUATE STUDENTS
PHYSICIANS ATTENDING 1947-1948 EXTENSION LECTURES

Course Given at Prince George's General Hospital, Cheverly, Maryland

Albert L. Anderson, M.D Annapolis, Md.

James E. Andrews, M.D Berwyn, Maryland

J. P. Bean, M.D Great Mills, Maryland

Joseph Berkenbilt, M.D Greenbelt, Md.

Samuel Borssuck, M.D Annapolis, Maryland

William Brainin, M.D Capitol Heights, Md.

Irving Burka, M.D Washington, D. C.

J. M. Byers, M.D Hyattsville, Md.

Thomas A. Christensen, M.D College Park, Md.

David S. Clayman, M.D Mt. Rainer, Md.

Aaron Dietz, M.D Hyattsville, Md.

William M. Eisner, M.D Greenbelt, Md.

WOLCOTT L. Etienne, M.D Berwyn, Maryland

Roland R. Fleischer, M.D Cheverly, Maryland

Leslie H. French, M.D Washington, D. C.

Irvin M. Grassgreen, M.D Mt. Rainer, Maryland

Charles C. Hageage, M.D Mt. Rainer, Maryland

George Hageage, M.D Cottage City, Maryland

Leonard Hays, M.D Hyattsville, Maryland

Lloyd Hughes, M.D Cheverly, Maryland

Page C. Jett, M.D Prince Frederick, Maryland

Louis M. Jimal, M.D Cottage City, Md.

Julius Kaufeman, M.D Bladensburg, Maryland

Julian S. Lane, M.D Leonardtown, Maryland

Oscar La vine, M.D Mt. Rainer, Maryland

John T. Maloney, M.D Cheverly, Maryland

Waldo B. Mayers, M.D College Heights, Md.

Robert S. McCeney, M.D Laurel, Maryland

George H. McLain, M.D Washington, D. C.

Helene D. Michael, M.D University Park, Maryland

Benjamin S. Miller, M.D Mt. Rainer, Maryland

James Sasscer, M.D Upper Marlboro, Maryland

Robert Sasscer, M.D Upper Marlboro, Maryland

Paul Van Nutta, M.D Parkland, Maryland

John M. Warren, M.D Laurel, Maryland

George J. Weems, M.D Huntingtown, Maryland

Hans Wodak, M.D Greenbelt, Maryland

Course Given at University Hospital for Carroll-Howard County Groups

S. Luther Bare, M.D Westminster, Maryland

C. " L. BiLLiNGSLEA, ]M.D Westminster, Maryland

MATRICULATES 99

George E. Btjegtorf, M.D Ellicott City, Maryland

Wilbur H. Foard, M.D Manchester, Maryland

J. Stanley Grabill, M.D Mt. Airy, Maryland

Gertrude M. Gross, M.D Sykesville, Maryland

Irene L. Hitchman, M.D Sykesville, Maryland

Reuben Hoffman, M.D Henryton, Maryland

Carl Wm. Jennette, M.D Westminster, Maryland

Thomas Hjenry Legg, M.D • Union Bridge, Maryland

James T. Marsh, M.D Westminster, Maryland

M. N. Mastin, M.D Sykesville, Maryland

Frank E. Shipley, M.D Savage, Maryland

W. Glenn Speicher, M.D Westminster, Maryland

L. C. Stitely, M.D New Windsor, Maryland

W. C. Stone, M.D Westminster, Maryland

Robert Hay Taylor, M.D Sykesville, Maryland

Charles S. Whitaker, M.D Clarksville, Maryland

Elizabeth Winiarz, M.D Sykesville, Maryland

WiTOLD Winiarz, M.D Sykesville, Maryland

Lewis K. Woodward, Sr., M.D Westminster, Maryland

Course Given at Washington County Hospital, Hagerstown, Maryland

Henry Aldis, M.D Sharpsburg, Md.

Jack H. Beachley, M.D Hagerstown, Md.

R. A. Bell, M.D Hagerstown, Md.

Owen H. Binkley, M.D Hagerstown, Md.

Lynn H. Brumback, M.D Hagerstown, Md.

William Dick Campbell, M.D Hagerstown, Md.

Robert vanLiew Campbell, M.D Hagerstown, Md.

Archle Robert Cohen, M.D Clear Spring, Md.

Robert P. Conrad, M.D Hagerstown, Md.

John W. Crawford, M.D Hagerstown, Md.

E. W. Ditto, Jr., M.D Hagerstown, Md.

J. R. DwYER, M.D Hagerstown, Md.

Philip J. Hirshman, M.D Hagerstown, Md.

Eldon G. Hoachlander, M.D Hagerstown, Md.

Lloyd A. Hoffman, M.D Hagerstown, Md.

John H. Hornbaker, M.D Hagerstown, Md.

George Jennings, M.D Hagerstown, Md.

Bender B. Kneisley, M.D Hagerstown, Md.

George A. Kohler, M.D Smithhurg, Maryland

Henry R. Kritzer, M.D Hagerstown, Md.

J. Walter Layman, M.D Hagerstown, Md.

Wm. T. Layman, M.D Hagerstown, Md.

G. W. LeVan, M.D Boonsboro, Md.

Elizabeth S. Linson, M.D Hagerstown, Md.

Frank F. Lusby, M.D Hagerstown, Md.

Victor D. Miller, M.D Hagerstown, Md.

Charles L. Mowrer, M.D Hagerstown, Md.

Sidney Novenstein, M.D Funkstown, Md.

Ernest F. Poole, M.D Hagerstown, Md.

Hubert L. Porterfeeld, M.D Hagerstown, Md.

L. M. Shaffer, M.D Hancock, Md.

Walter H. Shealy, M.D Sharpsburg, Md.

R. S. Stauffer, M.D Hagerstown, Md.

Halyard Wanger, M.D Shepherdstown, W. Va.

S. Robert Wells, M.D Hagerstown, Md.

Peregrine Wroth, Jr., M.D Hagerstown, Md.

W. Howard Yeager, M.D Hagerstown, Md.

Ralph F. Young, M.D Williamsport, Md.

S. Earl Young, M.D Hagerstown, Md.

Ira M. Zimmerman, M.D Williamsport, Md.

100

THE SCHOOL OP MEDICINM, UNIVERSITY OF MARYLAND

SUMMARY OF STUDENTS

September 18, 1947 to June 5, 1948

Medical Students Male

Senior Class 73

Junior Class 61

Sophomore Class 69

Freshman Class 92

295

Post-Graduate Intramural Courses 30

Special students 1

Students in Art as Applied to Medicine 0

Female

Total

322

326

354

GEOGRAPHICAL DISTRIBUTION OF MEDICAL STUDENTS

September 18, 1947 to June 5, 1948

Alabama 2

California 10

Maryland 156

Massachusetts

Michigan

Minnesota

Missouri

Nebraska

Colorado

Connecticut

Delaware

District of Columbia.

Florida

Georgia

Illinois

Indiana

Kansas

Nevada 1

New Hampshire 1

New Jersey 11

New York 12

North Carolina 11

Ohio 9

Oregon 1

Pennsylvania 28

Rhode Island 1

Texas 1

Utah. 2

Virginia 9

West Virginia 15

Wisconsin 1

United States Possessions

Puerto Rico 6

MEDICAL ALUMNI ASSOCIATION

OFFICERS 1948-1949
(Term beginning July 1, 1948 and ending June 30, 1949)

President
Albert E. Goldstein, M.D.

Vice-Presidents
E. Paul Knotts, M.D. James S. Billingslea, M.D. Charles C. Zimmerman, M.D.

Secretary Assistant Secretary Treasurer

Thurston R. Adams, M.D. Simon Brager, M.D. Charles Reid Edwards, M.D.

Executive Secretary
Mrs. Minette E. Scott

ENDOWMENT FUND

101

Board of Directors
Wetherbee Fort, M.D., Chairman
Albert E. Goldstein, M.D.
Thtxrston R. Adams, M.D.
Simon Brager, M.D.
Charles Reid Edwards, M.D.
Loins A. M. Krause, M.D.
Emil Novak, M.D.
William H. Trcplett, M.D.
Austin Wood, M.D.

Library Committee
Milton S. Sacks, M.D.

Editors
C. Gardner Warner, M.D.
John A. Wagner, M.D.

Representatives to General Alumni Association
Thurston R. Adams, M.D.
John A. Wagner, M.D.
William H. Triplett, M.D.

Nominating Committee
Frank Geraghty, M.D., Chairman
W. Raymond McKenzie, M.D.
Frank N. Ogden, M.D.
Robert F. Healy, M.D.
Ernest I. Cornbrooks, Jr., M.D.

Alumni Council
Louis H. Douglass, M.D.
Lewis P. Gundry, M.D.

ENDOWMENT FUND

The following constitute the Board of Trustees of this Fund:

Arthur M. Shipley, Chairman
Robertson Griswold
Harry Clifton Byrd
Albert Burns

H. Boyd Wylte, Secy.-Treas.

Charles Reid Edwards

Horace E. Flack

W. CoNWELL Smith

This Board is incorporated by act of the Legislature of the State, its legal title
being "The Trustees of the Endowment Fund of the University of Maryland,"
and is independent and self-perpetuating. Its powers are limited to the expendi-
ture of the interest derived from the various funds, which is applied as directed by
donors for the benefit of the University. Contributions, donations and bequests
are solicited from Alumni and friends. They may be made to the general or Uni-
versity Fund, to the Medical Fund or to any other department of the University.
If intended for the School of Medicine, they may be given to the general medical
fund or to some special object, as building, research, hbrary, pathology, hospital,
publication, laboratories, gymnasium, scholarship, medal, prize, etc., in which
case the wishes of the donor will be strictly regarded. Checks should be made
payable to The Trustees of the Endowment Fund of the Universit}' of Marj^land,
H. Boyd Wylie, Treasurer, Lombard and Greene Streets, Baltimore-1, Maryland.

FORMS OF DEVISE OR BEQUEST
To Endowment Fund

I give, devise and bequeath to the Trustees of the Endowment Fund of the University
of Maryland, a corporation incorporated under the laws of the State of Marj-land, for the
benefit of the Faculty of Medicine

(Here state amount or describe property)

102 THE SCHOOL OF MEDICINE, UNIVERSITY OF MARYLAND

To School of Medicine

I give, devise and bequeath to the Regents of the University of Maryland, a corporation
incorporated under the laws of the State of Maryland, for the benefit of the Faculty of
Medicine

(Here state amount or describe property)
THE UNIVERSITY OF MARYLAND SCHOOL OF NURSING

The University of Maryland School for Nurses was established in the year 1889.
Since that time it has been an integral part of the University of Maryland, coming
under the same government. It is a non-sectarian school, the only religious serv-
ices being morning prayers.

The University Hospital is a general hospital containing about 435 beds. It
is equipped to give young women a thorough course of instruction and practice in
all phases of nursing.

Programs offered: The programs of study of the school are planned for two
groups of students: (a) the five-year group, (b) the 36-month group.

The requirements for admission to the five-year program of the School of Nurs-
ing are the same as for other colleges of the University. The completion of this
course entitles the student to the degree of Bachelor of Science from the University
of Maryland and to the diploma of the University Hospital School of Nursing.

The requirements for admission to the 36-month program are the satisfactory
completion of an academic course in an approved high school. The completion
of this course entitles the student to the diploma of the University of Maryland
School of Nursing.

Applications and catalogues may be obtained from the Director of the School
of Nursing, University Hospital, Baltimore 1, Md.

' MERCY HOSPITAL SCHOOL OF NURSING

The Mercy Hospital School of Nursing was established in 1899 and in-
corporated on December 23, 1901. It is an integral part of the Mercy Hospital
and is under the same government. Mercy Hospital affords exceptional ad-
vantages for the education of nurses. It is a general hospital containing 348
beds, and offers opportunities for a thorough and varied experience. By its
institutional affiliation with the University of Maryland it secures professors who
give to the student the results of their training and experience in the fields of the
medical and affiliated sciences.

The University of Maryland, and Mount Saint Agnes College, in affiliation with
the Mercy Hospital School of Nursing, offer a five year combined Academic and
Nursing program. The completion of this course entitles the student to the degree
of Bachelor of Science from the University of Maryland and Mount Saint Agnes
College, and to the diploma of the Mercy Hospital School of Nursing. Graduate
nurses who hold college degrees are greatly in demand, especially for positions in
administration and teaching institutions. This program consequently offers a dis-
tinct advantage.

INDEX TO PERSONAL NAMES

Abraham, Robert Auman, 93

Acton, Conrad B., 13, 22, 23, S8, 59

Adam, Alberto, 97

Adams, Thurston R., 12, 19, 24, 35, 68, 73, 75, 100, 101

Agnesine, Sister M., 32

Aisenberg, Myron S., 9, 75

Aldis, Henry, 99

Alecce, Angelo Andrew, 89, 90, 91

Allison, George Malcolm, 89, 90, 91

Alvarez, Jose A., 57, 74

Amberson, William R., 8, 9, 56

Andersch, Marie A., 13, 59, 63

Anderson, A. Russell, 14, 64

Anderson, Albert L., 98

Anderson, Franklin B., 8, 9, 11, 19, 37, 71, 73

Anderson, George M., 75

Anderson, George W., 35

Andersen, William Andrew, 94

Andrews, James E., 98

Aponte, Joseph Louis, 32, 89, 90, 91

Applegarth, Eva, 34

Arnold, James G., Jr., 8, 11, 19, 27, 36, 74

Arthur, Robert Key, Jr., 95

Ashman, Leon, 14, 22, 32, 60, 61

Auld, David, 22, 89, 90, 91

Aycock, Thomas B., 9

Bachman, Leonard, 93

Bacon, A. Maynard, Jr., 31

Bacon, John Louis, 94

Baetjer, Walter A., 8, 11, 59

Baggett, Joseph W., 20

Baggott, Bartus T., 29

Bagley, Charles, 94

Bagley, Charles, Jr., 8, 9, 19, 27, 36, 37, 73

Bailey, Claude F., 31

Baker, Frank William, Jr., 89, 90, 91

Baldwin, Ruth B., 23

Ballard, Margaret B., 13, 25, 76

Banfield, Ernest E., 16, 76

Bankhead, J. Marion, 20

Bare, S. Luther, 98

Barnard, John William, 93

Barnes, Thomas G., Jr., 20

Barnett, Donald J., 13, 20, 79

Barthel, John Paul, 95

Bauer, Robert E., 16, 58

Baumann, Wilbur Nelson, 94

Beacham, Edmund G., 14, 35, 60

Beachley, Jack H., 99

Bean, J. P., 98

Beardsley, Earl Miller, 95

Beck, Harry McB., 16, 30, 33, 78

Beck, Harvey G., 8, 29

Behr, Eleanor, 31

Belkin, Joseph William, 93

Bell, Arthur Keith, 95

Bell, Frederick K., 18, 57

Bell, R. A., 99

Benjamin, William Philip, 93

Bennett, Sara Elizabeth, 93

Benson, John F., 21

Bereston, Eugene S., 13, 24, 29, 33, 67

Berger, Phillip R., 20

Bergland, J. McFarland, 11, 76

Berkenbilt, Joseph, 98

Bemadette, Mother M., 27

Berry, Robert Z., 16, 71, 97

Beyer, David Henry, 89, 90, 91

Biddix, Joseph C, Jr., 12, 75

Bilder, Joseph, Jr., 95

Billingslea, C. L., 98

Billingslea, James S., 100

Bills, Wilson Leo, 95

Bimestefer, Lawrence W., 36

Binkley, Owen H., 99

Bird, Joseph G., 16, 18, 57

Bireley, Beverly Robert, 95

Bisanar, James M., 22, 89, 90, 91

Bisgyer, Jay Lewis, 94

Bis, Hans, 35

Blackburn, Frances M., 16, 80

Blades, Nancy, 95

Blake, Charles F., 9

Bleecker, Harry Harlan, Jr., 94

Blum, Louis V., 23

Blundell, Albert Edward, 93

Bond, Donald Buckey, 89, 90, 91

Bongardt, Henry F., 12, 27, 68

Borden, Melvin N., 23

Bordley, John E., 36

Borges, Francis Joseph, 94

Borssuck, Samuel, 98

Bossard, John Wesley, 95

Bowen, Charles V., 20

Bowen, Joseph J., 31

Bowen, Paul Allen, 95

Bowie, Harry C, 14, 35, 54, 69

Bowers, John Z., 14, 60

Bowyer, Thomas S., 14, 77, 78

Boyd, Kenneth B., 13, 24, 25, 35, 77, 78

Bradford, Edward, 93

Bradford, George W., 18, 63

Bradley, J. Edmund, 8, 11, 19, 37, 65

Bradshaw, Raymond, Jr., 94

Brady, Leo, 12, 20, 77

Brager, Simon H., 12, 27, 32, 34, 68, 73, 100, 101

Brainin, William, 98

Brambel, Charles E., 30

Brannon, John Vandale, 95

Brantigan, Otto C, 8, 9, 35, 54, 68, 81

Briscoe, Ruth Lee, 8

Bronstein, Eugene Leonard, 89, 90, 91

Bronushas, Joseph Benedict B., 94

Brooks, Ross C, 23

Brouillet, George H., 14, 16, 25, 54, 69

Brown, Ann Virginia, 14, 57

Brown, Frances C, 16, 56.

103

104

INDEX TO PERSONAL NAMES

Brown, Hugh B,, Jr., 97

Brown, Thomas R., 37

Brumback, Frank E., 21

Brumback, Lynn H., 99

Bryant, Samuel H., 14, 20, 25, 75

Bryson, William J., 14, 58, 98

Bubert, Howard M., 8, 11, 23, 59, 81

Buchness, A. V., 16, 69

Buchness, John Michael, 32, 89, 90, 91

Buell, John Russell, Jr., 96

Bullock, John Boyd, 89, 90, 91

Bulluck, Matt Heyer, 89, 90, 91

Burgtorf, George E., 99

Burka, Irving, 98

Burkey, Fred Jamison, 94

Burleson, Morris, 98

Bums, Albert, 101

Bums, Harold H., 14, 28, 29, 32, 69

Bums, J. Howard, 30

Butler, Lillian, 31

Byerly, M. Paul, 13, 22, 60

Byerly, William L., 18, 20

Byers, J. M., 98

Byrd, Harry Clifton, 7, 101

Cacace, Vincent A., 97

CaldweU, Lucile J., 15, 24, 07

Campbell, Robert vanLiew, 99

Campbell, William Dick, 99

Caplan, Lester, 23

Carey, T. Nelson, 8, 18, 19, 22, 29, 47, 59

Carmel, Sister M., 27

Carr, C. Jelleff, 8, 11, 57

Chambers, Earl L., 29

Chambers, John W., 16, 27, 69, 74

Chambers, Robert G., 16, 18, 74, 76

Chambers, Thomas R., 8, 11, 27, 68

Chamovitz, Robert, 89, 90, 91

Chance, L. T., 16, 69

Chapman, Ross McC, 8, 9, 19, 64

Chase, Henry V., 31

Chelton, Alice Katherine, Graybill, 89,' 90, 91

Chelton, Louis Guy, 94

Chichester, Peter W., 7

Chum, Mary E., 15, 56

Christensen, Thomas A., 98

Christopher, Russell Lee, 96

Clapp, Clyde A., 9

Clarke, Carl Dame, 8, 11, 80

dayman, David S., 98

Clemmens, Raymond Leopold, 96

Cline, James Alexander, III, 93

Cloninger, Rowell Connor, 21, 97

Clough, Paul W., 8, 11, 59

Coberth, M. E., 37

Coblentz, Richard G., 8, 9, 19, 27, 56, 73

Coffman, Kaohlin Miner, 96

Cohen, Archie Robert, 99

Cohen, Cecelia E., 52

Cohen, Israel, 52

Cohen, Jonas, 16, 22, 60

Cohen, Morris M., 16, 24, 67

Cohen, Solomon, 96

Cohn, Jerome, 16, 60, 61

Cole, William P., Jr., 7

Golfer, Richard J., 15, 58

CoUenberg, H. T., 30

CoUer, Jerome Joel, 94

Compton, Beverley C, 8, 13, 20, 22, 24, 25, 35, 74, 78

Condron, James Frank, 89, 90, 91

Conner, Eugene C, 21

Conrad, Robert P., 99

Cooper, Donald D., 16, 33, 65

Cordi, Joseph M., 15, 33, 65

Cornbrooks, Ernest I., Jr., 13, 20, 24, 25, 35, 74, 78, 101

Cornelia, Sister M., 27

Corpenning, Tom Nye, 94

Correl, Shirley W., 23

Cotter, Edward F., 12, 19, 22, 23, 59, 66

Cotton, Albertus, 8, 28, 31, 36

Coughlan, Stuart G., 15, 69

Councill, W. A. H., 13, 19, 24, 72

Covington, E. Eugene, 31

Cowen, Joseph Robert, 94

Cowley, R. Adams, 21

Crabb, Gordon, 97

Cracraft, William Atkinson, 94

Crawford, John W., 99

Crecraft, Harold James, 89, 90, 91

Crosby, Robert M. H., 18, 74

Cross, Richard J., 21

Covey, William C, 21

Crouch, J. Frank, 8

Culver, Samuel H., 16, 69

Cunningham, Raymond M., 16, 24, 69, 73

Curanzy, Raymond Ralph, 96

Gushing, J. G. N., 12

Dalton, James Breckenridge, Jr., 89, 90, 91

Daly, Harold Lawrence, Jr., 94

Damian, Sister M., 27

Dann, Alfred H., 24

Dane, Edwin O., Jr., 16

Davidson, Charles N., 8, 11, 20, 79

Davies, Dean F., 36

Davies, Ross, 11, 67

Davis, Carl L., 8, 9

Davis, Charles M., 37

Davis, E. Hollister, 16

Davis, George H., 16, 77

Davis, James O., 36

Davis, John R., Jr., 15, 29, 32, 60

Deckelbaum. Joseph, 96

Deckert, W. Allen, 15, 24, 69, 78

DeHoff, John B., 16, 22, 60, 61

Deitz, Leonard Loeb, 94

Demarco, S., Jr., 28

Demarest, Elinor Weed, 94

Demarest, Lawrence Mann, 94

Demmy, Nicholas, 94

Dempsey, RajTnond Joseph, 89, 90, 92

Dennis, John, 21

Deringer, Florence Hurtt, 93

Dettbarn, Ernest Albert, 96

DeVier, Charles W., Jr., 22

Dickey, Francis G., 13, 19, 22, 59, 64

INDEX TO PERSONAL NAMES

105

Diehl, William K., 13, 20, 24, 25, 35, 74, 78

Dietz, Aaron, 98

Diggs, Everett S., 13, 20, 24, 25, 74, 78

Ditto, E. W., Jr., 99

Dixon, D. McClelland, 13, 58, 76

Dobbs, Edward C, 11, 20, 25, 75

Dodd, William A., 16, 30, 33, 78

Doeller, Charles H., Jr., 16, 30, 33, 77, 78

Donner, Leon, 96

Dorman, J. William, 35

Dorsey, Brice M., 9, 19, 25, 75

Douglass, Louis H., 8, 9, 18, 20, 35, 76, 101

Drake, Miles E., 21

Dudley, Winston Clark, 96

Duffy, William C, 16, 30, 33, 78

Dumler, John C, 13, 20, 24, 25, 35, 74, 78

Dunetz, Lora E., 25

Dunn, George Mitchell, Jr., 96

Dunnigan, William C, 16, 28, 32, 69

Dwyer, Frank Philip, Jr., 89, 90, 92

Dwyer, J. R., 99

Dye, Frederick C, 9

Eastland, J. Sheldon, 11, 29, 3i, 59

Eaton, Jay W., 53

Eaton, Martha C, 15, 25, 67

Ebeling, William C, III, 21

Edlow, Ernest S., IS, 30, 33, 78

Edmunds, Frederick Thomas, 94

Edmunds, Page, 8

Edwards, Charles Reid, 8, 9, 10, 18, 19, 37, 68, 100, 101

Edwards, David Everett, 96

Edwards, Monte, 8, 10, 19, 24, 36, 68, 73

Edwards, William Hunter, Jr., 96

Eisner, William M., 98

Elgin, William W., 12, 64

Ellis, Francis A., 12, 19, 24, 29, 3i, 67

Ensor, Robert E., 32, 89, 90, 92

Ensor, Wilmer Clifton, Jr., 93

Eppes, Williford, 21

Erwin, J. J., 13, 30, 33, 78

Esmond, William George, 96

Etienne, Wolcott L., 98

Eubanks, Otha Albert, Jr., 93

Evans, John E., Jr., 21

Evans, Otis Druell, Jr., 96

Everett, Houston, 13

Fargo, Leon K., 13, 29, 32, 72
Fearing, William L., 13, 23, 66
Feldman, Maurice, 12, 29, 33, 63
Ferguson, Charles Kirkpatrick, 96
Ferneyhough, Nancy Jane, 80
Ferris, Donald L., 97
Ferris, John A., 52
Fifer, Jesse S., 23
Figge, Frank H. J., 8, 10, 54
Fine, Morris A., 16, 22, 24, 60, 72
Fineman, Jerome, 13, 30, 3i, 65
Finkclstein, A. H., 8, 11, 19, 22, 23, 65
Fisher, Donald E., 16, 58
Fitzgerald, Joseph Carroll, 96
Fitzpatrick, Mary, 25

Fitzpatrick, Vincent dePaul, 31

Flack, Horace E., 101

Fleck, H. K., 10, 28, 78

Fleischer, Roland R., 98

Flynn, Philip D., 15, 29, 33, 60

Foard, Wilbur H., 99

Forman, Robert Blaine, 93

Fort, Wetherbee, 12, 29, 59, 81, 101

Fox, Samuel L., 13, 24, 71, 73

Frank, Bertha Rajmer, 50

Frank, Samuel Leon, 50

Fravel, Charles Richard, 93

Freedom, Leon, 8, 11, 19, 23, 58, 66

Freeman, Horatio Putnam, 96

Freeman, Irving, 13, 22, 59, 61

French, Leslie N., 98

Frey, Edward L., Jr., 30

Frey, Edward L., Sr., 33

Friedenwald, Edgar B., 8, 10, 29, 33, 6S

Friedenwald, Harry, 8, 28

Friedenwald, Jonas, 14, 78

Friedman, Paul N., IS, 25, 79

Fuller, Harvey L., 22

Fullilove, Jack, 96

Funk, Audrey M., 16, 60, 63

Funsch, Harold F., 97

Fusco, J. D., 29, 34

Fusting, William H., 16, 60, 61

Gaby, Elaine, 18

Gaither, A. Bradley, 50

Gakenheimer, William A., 21

Gallaher, James Patrick, 96

Galvin, Thomas K., 8, 10, 25, 30, 33, 77

Ganey, Joseph B., 21

Garcia-Palmieri, Mario Ruben, 96

Gardner, Maud M., 37

Gardner, William S., 8

Gareis, L. Calvin, 16, 25, 35, 77

Garlick, William L., 15, 28, 32, 69

Gaskel, Jason H., 15, 29, 32, 71

Gates, John Butler, 96

Gaver, Grason W., 10, 73

Gayle, John F., 21

Gehrmann, Frederica, 51

Gellman, Moses, 8, 11, 19, 26, 37, 71

Gephardt, Ruth L., 31

Geraghty, Frank J., 12, 22, 59, 101

Geraghty, William R., 17, 69

Gibbs, Robert Louis, 97

Gichner, Joseph E., 8

Gigliotti, Russell, 15, 20, 25, 75

Gill, Joseph Edward, 93

Gillis, Andrew C, 8, 10, 29, 30, 23, 66

Gillis, Francis W., 12, 32, 72

Ginsberg, Leon, 37

Glenn, George Waverly, 96

Click, Samuel S., 12, 23, 65

Gold, Benjamin M., 21

Goldsmith, Harry, 12, 30

Goldsmith, Selma R., 23

Goldstein, Albert E., 12, 58, 100, 101

106

INDEX TO PERSONAL NAMES

Golley, K. W., 29

Golombek, Leonard Harry, 89, 90, 92

Goodman, Howard, 23

Goodman, Julius, 28

Googins, Charles George, 94

Gordon, Benjamin Dichter, 96

Gorten, Martin Klaus, 93

Gould, Virginia Marie, 94

Govatos, George, 13, 68

Grabill, J. Stanley, 99

Graff, Henry F., 12

GranofE, H. L., 17, 30, 78

Grant, Bowie Linn, 89, 90, 92

Grassgreen, Irvin M., 98

Grauer, Franklin H., 36

Graves, James H., 21

Gray, David B., 21

Gray, Harry Williams, 93

Green, James William, 89, 90, 92

Greene, John P., 98

Greenstein, George Herbert, 94

Grill, Richard D., 17, 80

Griswold, Robertson, 101

Gross, Gertrude M., 99

Gross, Joseph B., 17, 22, 60

Guido, Angelina, 93

Guilbeau, Joseph A., Jr., 18, 63

Gundry, Alfred T., 101

Gundry, Lewis P., 22, 25, 59, 101

Gutman, Isaac, 32, 97

Hachtel, Frank W., 8, 9, 10, 57
Hagan, William B., 21, 98
Hageage, Charles C, 98
Hageage, George, 98
Hahn, Robert R., 21
Hahn, William E., 10, 75
Haines, John S., 17, 72
Hall, Howard E., 21
Hamperry, Leonard Gerard, 94
Hamrick, George Vincent, 89, 90, 92
Hankin, Samuel J., 15, 22, 60, 61
Hankins, John R., 22, 89, 90, 92
Hannan, Alice R., 34
Hanuan, Leon, 34
Hanrahan, Edward M., 35
Hardie, Dorothy, 25
Harman, John B., 18, 58
Harne, O. G., 7, 8, 9, 11, 55
Harne, William G., 57
Harris, James Radcliffe, 93
Harrison, Harold E., 8, 11, 35, 65
Hartz, Alvin J., 15, 60, 61
Hatem, Frederick Joseph, 96
Haught, John S., 17, 21
Hawkins, Charles W., 21
Hawkins, George Kenneth, 96
Hayleck, Mary L., 15, 37, 65
Hays, Leonard, 98
Healy, John Clauson, 94
Healy, Robert F., 15, 69, 101
Heath, William H., Jr., 97
Hebb, Donald B., 17, 24, 35, 73

Heldrich, Frederick J., Jr., 22, 89, 90, 92

Helfrich, Raymond F., 13, 28, 68

Helfrich, William G., 15, 23, 60, 61

Hellen, L. Ann, 17, 60, 63

Henderson, Charles Thomas, 93

Henneberger, Lowell P., 35

Henson, Stanley Willard, Jr., 94

Herpsberger, W. Grafton, 13, 23, 59, 61

Hetrick, Augustus C, 52

Hetrick, Bruce H., 52

Hetrick, Horace Bruce, 52

Heuman, Philip Walter, 94

Hibbitts, John T., 13, 24, 35, 78

Hicks, Hugh T., 12, 75

Hicks, Mary Elizabeth, 39

Highstein, Benjamin, 15, 24, 67

High tower, John A., 21

Himmelfarb, Sylvia, 17, 56

Hirschfeld, John H., 17, 20, 35, 36, 71

Hirshman, Philip J., 99

Hitchcock, Charles M., 51

Hitchman, Irene L., 99

Hoachlander, Eldon G., 99

Hoback, Florence Kunst, 89, 90, 92

Hobart, Richard Loren, Jr., 89, 90, 92

Hodes, Horace, 11, 67

Hoffman, Lloyd A., 99

Hoffman, Reuben, 99

Hofsteter, Grace, 94

Hogan, John F., 13, 24, 72

Hohman, Leslie B., 13

Holden, F. A., 15

Hollander, Mark B., 24

Holljes, Henry W. D., 13, 25, 60

Holloway, William J., 22, 89, 90, 92

Holter, Edward F., 7

Hooper, Z. Vance, 15, 23, 64

Hoover, Richard D., 21

Hopkins, John V., 17

Hopkins, Robert Charles, 96

Horine, Cyrus F., 8, 11, 68

Hornbaker, John H., 99

Howard, Ann, 21

Howell, Clewell, 13, 65

Hoyt, Irvin Gorman, 94

Hudson, Rollin C, 17, 23, 60

Huffer, Sarah Virginia, 94

Hughes, Lloyd, 98

Hull, Harry C, 10, 19, 68

Humphreys, Charles Wesley, Jr., 93

Hundley, J. Mason, Jr., 8, 9, 10, 18, 20, 24, 25, 35, 74, 77

Hunter, Richard E., 31

Hunter, Robert C, 21

Husted, Harriet Lamont, 94

Hutchins, Elliott H., 8, 10, 27, 68

Hutchison, William Forrest, 96

Hyle, John Charles, 95

Hyman, Calvin, 15, 68

Ibsen, Maxwell, 95
Iliff, Charles E., 36
Imburg, Jerome, 21
Ingram, C. Hal, 18, 21

INDEX TO PERSONAL NAMES

107

Inman, Conrad L., 29, 34

Insley, Marion Clarence Jr., 89, 90, 92

Isaacs, Benjamin H., 15, 28, 33, 71

Iten, George Joseph, 95

Iwamota, Harry K., 12, 57

Jacobson, Meyer W., 13, 23, 59
Jaffe, Albert, 11, 19, 65
Jenkins, Sarah Anetta, 95
Jennette, Carl, 99
Jennings, F. L., 8, 10, 27, 68
Jennings, George, 99
Jensen, Roy David, 95
Jeppi, Joseph V., 28, 34
Jerardi, Joseph V., 13, 28, 32, 68
Jett, Page C, 98
Jewett, Hugh, 17, 36, 72
Jimal, Louis M., 98
Johnson, Edward S., 8, 11, 68
Johnson, Elizabeth, 31
Johnson, Frederick Miller, 96
Johnson, Wallace Edward, 96
Joslin, Blackburn S., 21
Joslin, C. Loring, 8, 10, 18, 19, 65
Jubb, Charlotte, 39
Judd, Allyn F., 32
Judd, Charles W., 36

Kagan, H. N., 98

Kallins, Edward S., 15, 23, 60

Kaltreider, D. Frank, 13, 25, 35, 76

Kammer, William H., 32, 60

Kammer, William H., Jr., IS, 29

Kane, Harry F., 17, 30, 33, 78

Kardash, Theodore, 24, 78

Karel, Leonard, 14, 57

Karfgin, Arthur, 13, 22, 32, 60

Karlinsky, Ray Mintz, 51

Karn, William Nicholas, Jr., 96

Karns, Clyde F., 15, 68

Earns, James R., 17, 22, 47, 60

Kaschel, Paul Edward, 96

Kasik, Frank Thomas, 95

Kastner, Lee Norman, 89, 90, 92

Kaufiman, Julius, 98

Kaufman, Rajonond Henry, 89, 90, 92

Kayser, Fayne A., 15, 28, 33, 71

Kelley, Gordon William, 95

Kellogg, W. K.,53

Kemick, Irvin Bernard, 23

Kemler, Joseph I., 13, 28, 78

Kemp, Katherine Virdin, 89, 90, 92

Kennedy, Carl Hubert, Jr., 89, 90, 92

Kennedy, Margaret, 37

Kiatsu, Frederick Go, 21

Kilby, Walter L., 8, 10, 18, 20, 79

Kindt, Willard Freed, 96

King, Victor Francies, 96

Kipnis, David Morris, 96

Kirk, Florence R., 39

Kirkpatrick, Crawford N., 36

Kitlowski, Edward A., 8, 10, 28, 35, 37, 76

Kline, Raymond F., 18, 56

Knabe, George William, Jr., 93

Knapp, Hubert C, 29

Kneisley, Bender B., 99

Knipp, Harry Lester, 96

Knotts, E. Paul, 7, 100

Knowles, F. Edwin, Jr., 13, 20, 25, 28, 79

Kohler, George H., 99

Kohn, Schuyler, 17, 77

Kolman, Lester N., 24

Koontz, Amos, 35

Krahl, Vernon E., 8, 11, 54

Kramer, Howard Calvin, 96

Krantz, John C, Jr., 8, 10, 57, 81

Krause, Louis A. M., 8, 10, 18, 22, 29, 36, 59, 80, 81, 101

Kremen, A., 15, 79

Kritzer, Henry R., 99

Kroll, Louis J., 15, 60, 61

Krop, Stephen, 14, 57

Kyper, Frederick T., 13, 20, 36, 71, 73

Lacy, Marvin, 17, 18, 74, 76

Lamb, William Eugene, 96

Lambert, H. James, 21

Lane, Elizabeth, 37

Lane, Julian S., 98

Langeluttig, H. Vernon, 12, 35, 59

Lanning, Theodore Reuney, 96

Lavenstein, Arnold F., IS, 23, 65

Lavine, Oscar, 98

Lawler, Lillian Marie, 31

Layman, J. Walter, 99

Layman, William T., 99

Leach, C. Edward, 13, 23, 59

Lederman, Alfred S., 17, 23, 64

Legg, Thomas Henry, 99

Legge, John E., 29

Legge, Kenneth D., 8, 10, 29, 32, 72

Legum, Samuel, 13, 59, 61

Leibman, Jack, 96

Leitz, R. Frederick, 29

Leograndis, Stephen Cosmos, 89, 90, 92

Lerner, Philip L., 12, 30, 33, 66

Leslie, Franklin E., 17, 22, 60

LeVan, G. W., 99

Levin, H. Edmund, 14, 57

Levin, Manuel, 23

Levinson, Lorman L., 21

Levy, Kurt, 15, 22, 60, 61

Lewis, Thomas Earl, 93

Lewis, Thomas Franklin, Jr., 95

Ley, Leo Henry, Jr., 96

Liberto, Joseph R., 97

Lichtenberg, Joseph David, 95

Linden, Arthur J., 31

Link, V. Harwood, 17, 24, 67

Linson, Elizabeth S., 99

LaPira, Joseph F., 31

Lisansky, Ephraim T., 14, 22, 58, 59

Lister, Leonard Melvin, 96

Lithgow, Charles Henry, 89, 90, 92

Locher, R. W.,8, 11, 27, 68

Lock, Burton Vernon, 93

Lockard, G. Carroll, 8, 10, 19, 59, 75

108

INDEX TO PERSONAL NAMES

Loewald, HansW., 12, 23, 64

Loker, F. Ford, 17, 28, 32, 69

London, Nathaniel Jacob, 93

Long, Edgar F., 7

Long, W. Newton, 35

Longley, George Henry, 93

Looper, Edward A., 8, 10, 19, 20, 37, 71

Love, Robert George, 96

Love, William S., Jr., 8, 11, 19, 59

Ludes, Hans, 18, 56

Lukens, James Thomas, 93

Lusby, Frank F., 99

Lutz, John F., 8, 12, 55

Lynn, William D., 21

MacDonald, James Melvin, 96
Macgowan, Birkhead, 28
Macht, Stanley H., 8, 12, 35, 79
Mack, Harry Patterson, 22, 89, 90, 92
Maengwyn-Davies, G. D., 18, 58
Maginnis, Helen I., 17, 24, 78
Magladery, J. W., 36
Magness, Thomas H., 22
Malcarney, Alberta Rose, 93
Maldeis, Howard J., 8, 11, 58, 59, 67
Mallis, Nicholas, 22, 89, 90, 92
Maloney, John T., 98
Mansberger, Arlie R., Jr., 21
Mansdorfer, G. Bowers, 14, 29, 65
Mansfield, W. Kenneth, Jr., 17, 25, 77
Marek, Charles B., 17, 24, 78
Marriott, Henry J., 15, 33, 60
Marsh, James T., 99
Marshall, Joseph H., 15
Martin, Clarence W., 17, 25, 77
Martin, George William, Jr., 95
Martin, Glenn L., 7
Maseritz, I. H., 14, 29, 32, 71
Mastin, M. N., 99
Mattax, Harry McCoy, 93
Matthews, Burton Vincent, 89, 90, 92
Matthews, Mary Elizabeth, 93
Matthews, Roland Dellwood, 89, 90, 92
Maxson, Charles W., 8, 11, 28, 68
May, Homer Woodrow, 93
Mayers, Waldo B., 98
Mays, Howard B., 12, 19, 22, 24, 36, 58, 72
McAlpine, James G., 11
McCarthy, Harry B., 37, 75
McCauley, Betty Jane, 89, 90, 92
McCeney, Robert S., 98
McClelland, D., 25
McClung, William D., 31
McCord, Charles Frederick, 93
McCormick, Charles P., 7
McCrumb, Fred R., Jr., 22, 89, 90, 92
McElvain, Norma Feik, 57
McElvain, Wilbert Harding, 95
McElwain, Howard B., 17, 28, 69
McFadden, Earl Boyd, 96
McFadden, John William, 96
McFadden, Robert B., 97
McFaul, William N., Jr., 28

McGrady, Charles Winifred, Jr., 96

Mcintosh, Edith R., 39

McKenzie, W. Raymond, 14, 28, 71, 101

McLain, George H., 98

McLaughlin, Francis J., 15, 64

McLean, George, 12, 29, 59, 75

McMillin, Parker J., 35

McNally, Hugh B., 14, 20, 25, 30, 76

McNinch, James R., Jr., 21

Mearns, Robert B., 24, 37

Mech, Karl F., 15, 24, 54, 58

Mendez-Bryan, Ricardo Tomas, 96

Meranski, Israel P., 15, 23, 30, 33, 65

Merkel, Walter C, 11, 30, 58

Merrill, George G., 36

Metcalf, John Shelby, 18, 54, 56, 97

Miceli, Carmela E., 31

Michael, Helene D., 98

Middleton, Edmund B., 18, 54, 93

Millan, Lyle J., 14, 19, 24, 72

Miller, Benjamin S., 98

Miller, Dorothea Anna, 95

Miller, Joseph M., 14, 68

Miller, Max Jay, 93

Miller, Robert Eugene, 95

Miller, Victor D., 99

Mitchell, George W., 28

Mitchell, William A., 17, 24, 25, 77, 78

Mohler, Donald Ignatius, Jr., 89, 90, 92

Montgomery, D. Otis, 31

Moores, J. Duer, 15, 25, 68, 74

Morgan, Zachariah, 8, 12, 64

Morris, Frank K., 14, 30, 33, 77, 78

Morrison, J. Huff, 15, 22, 25

Morrison, John H., 77

Morrison, Samuel, 11, 59, 63

Morrison, Theodore H., 8, 10, 29, 63

Mosberg, William H., 21

Mosser, Robert Schaaf, 96

Mowrer, Charles L., 99

Moyer, John Lewis, III, 93

Muller, S. Edwin, 14, 15, 29, 32, 60, 63

Murdock, Harry M., 12, 64

Muse, Joseph E., Jr., 15, 22, 60, 61

Musser, Joseph E., Jr., 15

Musser, Ruth, 57

Mutter, Arthur Zelig, 96

Myers, Donald Johnson, 96

Myers, Evangeline, 95

Myers, John A., 15, 60

Nelson, Alfred T., 8, 12, 20, 80
Nelson, James W., 12, 18, 28, 33, 68
Netterville, Rush E., 97
Neumayer, Francis, 93
Newell, Edward Alphonso, 89, 90, 92
Newell, H. Whitman, 11, 19, 23, 64
Newell, Josephine Evelyn, 93
Nicklas, Gilbert Lee, 93
Niermann, William A., 22
Niswander, Guy Donald, 89, 90, 92
Noguera, Julio Tomas, 95
Nolan, Paul Vernon, 89, 91, 92

INDEX TO PERSONAL NAMES

109

Novak, Emil, 8, 11, 76, 101
Novenstein, Sidney, 99
Novey, M. Alexander, 12, 76
Novey, Samuel, 15, 64
Nuttall, Ernest B., 10, 75
Nuttle, Harry H., 7
Nygren, Edward Joseph, 96

O'Connor, John A., 28

O'Donnell, Charles F., 32

Ogden, Frank N., 101

Oliver, Norman, 97

O'Malley, Joseph Edward, 95

O'Rourk, Thomas R., 8, 10, 19, 20, 24, 36, 71, 73

Orth, John Stambaugh, 96

Osborne, John C, 17, 29, 32, 60

Oster, Robert H., 8, 10, 56

Otanasek, Frank J., 17, 27, 74

Owings, James C, 35

Pacienza, F. A., 28, 34

Packard, Douglas Richard, 96

Padget, M. Paul, 15, 60

Padussis, Stephen Konstant, 89, 91, 92

Paine, Robert M., 36

Panzarella, John Henry, 93

ParelhofE, Merrill Elliott, 93

Parr, William A., 15, 73

Patterson, J. Milton, 7

Paula Marie, Sister, 31

Peake, C. W., 8, 11, 63

Pembroke, Richard H., Jr., 15, 23, 64

Pencheff, Dorris Marie, 96

Perez, Julietta, 31

Perilla, Frank Robert, 96

Perry, Henry David, Jr., 96

Pertz, Elden H., 31

Pessagno, D. J., 8, 10, 27, 68

Pessagno, Eugene L., 15, 20, 25, 75

Peters, H. Raymond, 8, 10, 27, 29, 32, 59

Petersen, Phyllis Ann, 22, 89, 91, 92

Phelan, Patrick C, Jr., 17, 28, 32, 69

Phelps, Winthrop M., 37

Pierpont, Ross Z., 15, 54, 69

Piggott, John B., Jr., 21

Pincoffs, Maurice C, 7, 8, 10, 18, 19, 27, 29, 59

Pincoflfs, Susan R., 17, 25

Pittman, Robert Raikes, 93

Piatt, Julian Jay, 89, 91, 92

Pleet, Jerome, 93

Podolnik, Aaron, 18, 23, 64

Polek, Melvin F., 32

Poole, Ernest F., 99

Porterfield, Hubert L., 99

Powell, Albert M., Jr., 32, 89, 91, 92

Preinkert, Alma H., 7

Proctor, Samuel E., 15, 24, 69

Pruitt, Hazel Y., 17, 57

Queen, J. Emmett, 29, 32, 33

Rabhan, Leonard J., 98
Raby, William R., 98
Raby, William T., 21

Ramundo, Michael R., 97

Randolph, Kenneth, V., 10, 75

Range, James J., 21

Raskin, Howard Frank, 93

Raskin, M., 28, 34

Rathbun, Howard K., 36

Reahl, Joseph D., 31

Redding, Joseph Stafford, 89, 91, 92

Reeder, J. Dawson, 8

Reese, Frederick M., 17, 25, 79

Reese, J. G. M., 8, 11, 20, 76

Reese, J. Morris, 35, 81

Reeser, Guy McLelland, Jr., 96

Reeves, Henry Gray, Jr., 96

Reich, Walter G., Jr., 18, 54

Reifschneider, Charles A., 8, 10, 18, 35, 68, 75

Reifschneider, Herbert E., 14, 54, 68

Reilly, Kathleen Margaret, 96

Reimann, Dexter L., 8, 12, 19, 58

Reiter, Robert A., 14, 59, 61

Revell, Samuel T. R., Jr., 14, 19, 22, 59

Raver, William Benjamin, Jr., 95

Reynaud, Louis Favrot, Jr., 95

Reynolds, Georgia, 97

Rex, Eugene Braiden, 96

Rhyne, Jimmie Lee, 89, 91, 92

Rice, Robert Milton, 97

Rich, Benjamin S., 11, 24, 28, 37, 71, 73

Richards, Esther L., 35

Richardson, Paul Frederick, 95

Riddel, Clifford Thurston, Jr., 94

Ridgely, I. O., 12, 28, 68

Rienhoff, William F., Jr., 14, 27, 68

Rigdon, Henry L., 14, 35, 54, 68

Righetti, Milton Raymond, 95

Rizika, Stuart, 24

Robinson, Daniel R., 15, 28, 32, 68

Robinson, Harry M., Jr., 12, 19, 24, 59, 67

Robinson, Harry M., Sr., 8, 10, 19, 24, 37, 67, 75

Robinson, Ida Marian, 39

Robinson, R. C. V., 14, 24, ii, 67

Rodriguez, Edsel Antonio, 89, 91, 92

Roehrig, Charles Burns, 94

Rogers, Harry L., 8, 10, 28, 32, 37, 71

Rolando, Anne H., 52

Rolando, Henry, 52

Rombro, Marvin Jay, 97

Rosen, Robert Reuben, 94

Rosser, John H., 21

Roth, Oliver Ralph, 95

Rothschild, Stanford Z., 7

Rovelstad, Howard, 39

Rowland, Harry Shepard, Jr., 97

Rowland, J. M. H., 8

Rubin, Seymour Howard, 95

Rubin, Seymour W., 15, 58

Rudolph, Robert Lee, 89, 91, 92

Rudy, Norman Edward, 95

Russo, James, 17, 80

Rysanek, William J., Jr., 17, 30, 78

Saavedra-Amador, Armando, 97

Sacks, Milton S., 9, 11, 18, 22, 58, 59, 63, 81, 101

110

INDEX TO PERSONAL NAMES

Sanderson, William R., 53

Sandler, Robert, 95

Sanford, William Gordon, 92

Sarewitz, Albert Bernard, 94

Sargent, George, 101

Sasscer, James, 98

Sasscer, Robert, 98

Sauerwald, Mary J., 18, 58

Saunders, Joseph H., 97

Savage, John E., 12, 20, 35, 76

Sayles, Harold A., 18, 19

Scarborough, Clarence P., 16, 24, 28, 32, 35, 76

Schaefer, John F., 16, 32, 69

Scher, Jordan Mayer, 94

Scherr, Merle Sundrell, 89, 91, 92

Schmale, Arthur Henry, Jr., 94

Schmidt, Emil G., 10, 57

Schnaper, Nathan, 94

Schreiber, Richard David, 94

Schultz, Kathryn L., 14, 23, 64

Schwalm, Charlotte, 31

Schwartz, Benson Charles, 89, 91, 92

Schwartz, Theodore A., 14, 28, 33, 71

Schwarz, Virginia, 31

Scott, Minette E., 100

Scott, Roger David, 97

Scully, John Thorsen, 97

Seabold, William M., 16, 19, 30

Seegar, J. King B. E., Jr., 17, 25, 77

Seigman, Edwin L., 18, 21, 79

Seliger, R. V., 37

Sendelback, Bertha, 37

Serra, Lawrence M., 14, 59

Settle, WUliam B., 14, 24, 54, 68

Shafer, Cecil, 21

Shaffer, L. M., 99

Shamer, Miriam Abbott, 95

Shapiro, A. Albert, 14, 24, 67

Shaw, Grace E., 20

Shawbaker, Anna, 34

Shea, William Howard Holland, 97

Shealy, Walter H., 99

Shear, Joseph, 21

Sheehan, Joseph C, 17, 30, 33, 78

Shell, James H., 21

Shell, John Robert, 32, 89, 91, 92

Sheperd, Frederick Parker, 95

Sheppard, Robert C, 16, 23, 24, 69

Sherrard, Margaret Lee, 94

Sherrill, Elizabeth D., 22, 61

Sherry, Samuel Norman, 97

Shipley, Arthur M., 8, 10, 101

Shipley, E. Roderick, 17, 24, 69

Shipley, Frank E., 99

Shocat, Albert J., 16, 23, 64

Shock, Nathan W., 36

Siegel, Isadore A., 12, 20, 76

SOverman, Benjamin K., 89, 91, 92

Silverstein, Daniel Lewis, 89, 91,|92

Simmons, Frederic Rudolph, Jr., 95

Sipple, Edward N., 97

Sires, William Oscar, 95

Siwinski, Arthur G., 14, 25, 32, 36, 68,[74

Siwinski, Thaddeus C, 32, 89, 91, 92

Skipton, Roy Kennedy, 97

Skitarelic, Benedict, 14, 58

Sklar, Allen Leon, 95

Smelser, Rennert M., 32, 89, 91, 92

Smith, Boylston Dandridge, Jr., 95

Smith, Dietrich Conrad, 9, 11, 56, 81

Smith, Edward P., 12, 27, 30, 33, 78

Smith, Frederick B., 11, 29, 65

Smith, George W., 21

Smith, Luther E., 36

Smith, Meredith Parks, 94

Smith, Morton, 95

Smith, R. Dale, 9, 12, 54

Smith, Ruby A., 16, 25, 79

Smith, Sol, 12, 29, 32, 59, 63

Smith, W. Conwell, 101

Smith, William H., 9, 11, 59

Snider, Kenneth Bruce, 94

Snyder, Jerone, 17

Snyder, Samuel, 17, 60

Snyder, William Allen, 89, 91

Solomon, David Milton, 97

Sosnowski, Andrew Raymond, 95

Spaulding, Raymond Charles, Jr., 95

Spear, Irving J., 8, 19, 37

Speed, William G., Ill, 36

Speicher, W. Glenn, 99

Spencer, Hugh R., 9, 10, 19, 30, 37, 58

Spittel, John Allen, Jr., 94

Sprunt, Thomas P., 9, 10, 19, 29, 59

Spurrier, O. Walter, 17, 30, 33, 65

Stahl, Robert Ray, 89, 91, 92

Stahler, Earlin John, 94

Stanfield, Elwin Eugene, 94

Startzman, Henry Hollingsworth, Jr., 95

Stauffer, R. S., 99

Steckler, Robert Joseph, 94

Stegmaier, James G., 31

Stein, Carl Christian, 80

Steiner, Albert, 24

Stevenson, Edward Ward, 94

Stewart, Edwin H., Jr., 17, 25, 69

Stiles, Cleo D., 16, 25, 79

Stitely, L. C, 99

Stone, John Hoskins, 97

Stone, Robert L., 21

Stone, W. C, 99

Storm, Mary Elizabeth, 95

Strahan, John Franklin, 94

Strauss, George A., Jr., 30

Sulka, Casimir Michael, 95

Sunday, Stuart D., 17, 60, 61

Supik, WUliam J., 17, 24, 73

Swisher, Kyle L., Jr., 22, 89, 91, 92

Swiss, Adam, 17, 60

Tappan, Benjamin, 37

Tarr, Norman, 89

Tarun, William, 8

Tate, Allen Denny, Jr., 89, 91, 92

INDEX TO PERSONAL NAMES

111

Taussig, Helen M., 37

Tawab, Salah A., 23

Taylor, Robert Hay, 99

Teitelbaiim, Harry A., 14, 23, 66

Tenner, David, 16, 60

Theverkauf, Frank J., Jr., 22, 89, 91, 92

Thibadeau, Robert TorndorS, 95

Thomas, Clyde D., 32, 89, 91, 92

Thomas, Ramsay B., 23

Thomison, James S., 98

Thompson, Raymond K., 17, 24, 27, 36, 74

Thompson, S. M., 37

Thompson, William Wesley, 95

Thornfeldt, Robert E., 35

Thuss, William Getz, Jr., 89, 91, 93

Tilley, Russell McFarlane, Jr., 94

Timanus, James Kyner, 94

Tinker, Paul, 21

Tobias, Richard Boyd, 97

Toomey, Lewis C, 13, 20, 25, 75

Tongue, R. Kent, 36

Touhey, T. J., 17, 28, 69

Toulson, W. Houston, 9, 10, 19, 24, 36, 72

Townshend, Wilfred H., Jr., 16, 23, 60

Tramer, Arnold, 94

Trettin, Gene Douglas, 94

Trunble, P. Ridgeway, 13, 28, 32, 35, 68

Triplett, William H., 101

Truitt, Edward B., 18, 58

Truitt, Ralph P., 9, 10, 19, 23, 64, 81

Tuerk, Isadore, 14, 64

Tumminello, S. A., 29

Tunney, Robert B., 17, 30, 33, 78

Turner, Philip C, 7

Twigg, Homer Lee, Jr., 97

Tydings, Millard E., 7

Udel, Melvin, 97

Uhlenhuth, Eduard, 9, 10, 54, 81

Ullrich, Henry F., 9 11, 19, 24, 29, 32, 36, 37, 71

Ullsperger, John F., 31

Upton, Albert Louis, 95

Valentine, Clarence Eldred, 97

Vandegrift, William D., 16, 58

Van Goor, Kornelius, 95

Van Lill, Stephen J., Ill, 17, 23, 60

Vanni, Frank, 97

Van Nutta, Paul, 98

Varipatis, Michael S., 36

Vazzana, Hugh, 98

Vencent, Sister M., 34

Vcnrose, Robert James, 97

Veronica, Sister M., 27

Vicens, Enrique A., 95

Vincent, Sister M., 27

Vollmer, Frederick J., 16, 29, 32, 60

Voshell, Allen Fiske, 9, 10, 19, 20, 24, 36, 71, 81

Vyner, Harold, 16, 64

Waghelstein, Julius M., 36

Wagner, John A., 9, 13, 19, 36, 58, 63, 74, 81, 101

Wagner, Philip S., 13, 64

Walker, James, 98

Walker, W. Wallace, 13, 54, 68

Waller, William K., 14, 22, 59

Walters, Hezekiah G., Jr., 89, 91, 93

Walton, Henry J., 8, 37

Wanger, Halvard, 99

Ward, Arthur, 33

Ward, Grant E., 9, 11, 20, 24, 36, 68, 74, 75

Ware, Charles Ingersoll, 89, 91, 95

Warfield, Clarence, 52

Warfield, Genevra, 52

Waring, H. Glenn, 35

Warner, C. Gardner, 9, 11, 35, 58, 101

Warnock, Robert George, 94

Warren, John M., 98

Warthen, WOliam H. F., 12, 66

Waterman, Roger Sherman, 89, 91, 93

Watson, Charles Polk, Jr., 97

Watson, Frank Yandle, 94

Weekley, Robert Dean, 97

Weeks, Earl, 33

Weeks, Thomas E., 23

Weeks, WUliam Earl, 18, 37, 65

Weems, George J., 98

Weiland, Glenn S., 12, 57

Welborn, James Todd, 89, 91, 93

Welch, Elbert Sylvester, 94

Welch, Hugh J., 29

Wells, Gibson J., 14, 23, 37, 65

Wells, S. Robert, 99

Weston, Joyce, 23

Wheelright, Harvey Pearse, 97

Whitaker, Charles S., 99

White, Fowler Felix, 95

White, John P., Ill, 21

Whitehorn, Clark Allan, 89, 91, 93

Whitehurst, Mrs. John L., 7

Wich, J. Carlton, 17, 23, Si, 65

Wilder, Milton J., 14, 24, 36, 37, 71

Wilfson, Daniel, Jr., 16, 60, 61

Will, David R., 21

Williams, Charles H., 22

Williams, Charles Ray, 97

Williams, Huntington, 9, 10, 66

Wilson, Clifford Edward, Jr., 95

Wilson, John Dean, 89, 91, 93

Winiarz, Elizabeth, 99

Winiarz, Witold, 99

Winship, Emma, 22

Winslow, Randolph, 51

Winterringer, James R., 21

Wise, Walter D., 9, 10, 27, 68

Wisong, Georgiana, 37

Wodak, Hans, 98

Wolf, Ernest Simon, 95

Wolfe, Carolyn DeWitt, 94

Wolfe, Harvey Edward, 97

Wolfi, Thomas C, 9, 12, 29, 32, 59, 61

Wolfram, Betty, 31

Womack, William Spengler, 89, 91, 93

Wood, Austin H., 14, 72, 101

112

INDEX TO PERSONAL NAMES

Wood, Margaret Wetherill, 97
Woodward, Lewis K., Sr., 99
Woodward, Theodore E., 9, 12, 18, 59
Worsley, Thomas L., 18, 60, 61
Wright, Isaac, 21, 98
Wright, Robert B., 9, 12, 58
Wroth, Peregrine, Jr., 99
Wylie, H. Boyd, 7, 8, 9, 10, 18, 101

Yeager, George H., 9, 10, 18, 22, 23, 25, 35, 68, 75

Yeager, W. Howard, 99

Yeager, William Howard, Jr., 95

York, Shelley Clyde, Jr., 97

Yoimg, Asa D., 13, 31, 79

Young, Calvin Lessey, 97

Young, Edgar W., 31
Young, John Paul, 89, 91, 93
Young, Ralph F., 99
Young, S. Earl, 99

Zapf, Evelyn Byrd, 37
Zeligman, Israel, 14, 24, 67
Ziegler, John Bosley, 94
Zimmerman, Charles C, 100
Zimmerman, Ira M., 99
Zimmerman, Muriel, 37
Zinn, Waitman P., 9, 10, 27, 28, 33, 71
Zupnik, Harold L., 18, 28
Zupnik, Howard L., 32, 69
Zuravin, Meyer H., 28

The Frank C. Bressler Research Laboratory

University Hospital

K«Lr\(Un<i. University. 2*011001 o9 Wte<iicine . f3»u.Ue1:ii

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Full text of "Bulletin of the University of Maryland School of Medicine 1948-1949"

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